The Doctors’ Lounge
Where scalpels meet systems — and physicians say what they really think.
Co-hosted by Anish Koka, MD & Anthony DiGiorgio, DO. Candid talks on healthcare policy, reform, physician autonomy & patient care.
The Doctors’ Lounge
Inside a $207 Million Verdict: What Every Physician Should Know About Malpractice Trials
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Episode Summary
In a special Tuesday episode, Anish Koka and Anthony DiGiorgio sit down with Heather Tereshko, a Principal at Post & Schell in Philadelphia and a 25-year veteran of medical malpractice defense, to break down the largest medical malpractice verdict in Pennsylvania history — a $207 million judgment against the University of Pennsylvania stemming from a delayed C-section and resulting anoxic brain injury. Using the case as a launching pad, the three walk through how verdict slips are constructed, why Pennsylvania's "increased risk of harm" standard makes cases easier for plaintiffs to win, how EMR documentation gets weaponized against physicians on the stand, how life-care-plan and non-economic damages get inflated (including "anchoring" tactics like invoking Jalen Hurts's salary), and why juries so often disregard clinical guidelines in favor of narrative and sympathy. The conversation closes with a practical, if sobering, discussion of what physicians could realistically lobby for — tighter expert witness standards, damage caps, and organized legislative pressure — and why none of it is coming easily.
Chapter Markers
00:19 Special Tuesday episode and guest introduction: Heather Tereshko
03:22 Heather's background in malpractice defense
05:40 The $207M Penn verdict: how the case started
09:20 Why this is a typical "bad baby" case
11:49 EMR drop-downs and documentation gaps at the center of the case
14:45 The cord blood dispute and the mechanism-of-injury fight
16:01 Judge excludes key testimony on the blood draw
18:33 Inside the verdict slip: factual cause vs. increased risk of harm
25:50 Why "increased risk of harm" doesn't fit this case
27:20 The "team theory" of liability and how the verdict sheet was structured
31:39 Breaking down the $207M damages award
33:06 The life expectancy fight: 29 years vs. 70 years
36:20 Anchoring tactics and the Jalen Hurts salary comparison
39:21 How contingency fees work in Pennsylvania
42:04 "There's no winning": defensive medicine and no-win scenarios
45:14 When health system interests diverge from the individual physician's
46:25 Downstream effects: why community hospitals drop OB services
47:39 No-fault alternatives: New Zealand and Florida's birth injury fund
51:57 Expert witness accountability — or the lack of it
55:58 Venue selection and how it reshaped Philadelphia verdicts
59:04 Damage caps and why economic damages remain unbounded
1:01:54 What physicians can realistically lobby for
1:06:06 Closing thoughts
Substack References (Dr. Anish Koka)
Referenced during the episode — Anish's Substack posts on the Pennsylvania medical malpractice market and on the Penn ($207M) verdict:
PA malpractice market / NAIC data post: https://anishkokamd.substack.com/p/pennsylvania-had-a-functioning-medical
Penn verdict case breakdown post: https://anishkokamd.substack.com/p/twelve-people-three-hours-a-207-million
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@anish_koka and @drdigiorgio
Show Handle
@drsloungepod
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SPEAKER_02Nobody knew that healthcare could be so complicated. It finally beat Medicare. This is the Doctor's Lounge.
SPEAKER_01Okay, we are live on a special episode of the Doctor's Lounge this evening. It's a Tuesday, not a Thursday, which is our usual day. But we're very excited to have a great episode lined up. Our guest today is Heather Tereshko. She's a principal at Post and Shell in Philadelphia in the firm's professional liability department and its medical malpractice defense group. So she's for the physicians and the out there that who automatically turn off when they hear medical malpractice, Heather is working to defend you. She's been doing this for 25 years. First chair, second chair, jury trials, arbitrations. She's defended essentially every major health system in the region and the physicians who work inside of them. You name it, what the cases are delayed cancer diagnoses, perioptic complications, obstetrical catastrophes, emergency medicine. These are cases where the injury is severe, the damages are catastrophic, and uh the numbers that are being bandied around can certainly bankrupt institutions and careers. I met Heather at a conference and a panel on the subject of the Pennsylvania medical malpractice market and why there were some significant problems with the medical malpractice market. As most physicians, I just sign a check every year to re-up my medical malpractice and every year it goes up. This year the jump was much more than before. And I don't have a good understanding exactly of why or what is happening. So it was really interesting when I moderated this panel. I was forced to kind of get into the weeds of what's going on with the medical malpractice climate. And it's really startling to see what's happening in the medical malpractice market and the fact that a lot of what's happening is the result of legislative action that is kind of setting up a certain infrastructure. So what's happening is this is this is not a bug in the system. This is a system designed to operate as it has been legislatively designed to operate. So I wrote a Substack post a few months ago after I moderated this panel, kind of digging into the weeds using data from the NAIAC, which stands for the National Association of Insurance, something or the other, National Association of Insurance Commissioners, which releases data on things like direct premiums written, direct premiums earned, the loss ratios to get a sense of what's happening to the Pennsylvania market and what's happening nationally. We'll link to that Substack post as well. There's a ton of jargon-related insurance that's in there. But I think it's incredibly important for physicians to know about. And that's the thing that came away from that panel. Like, my God, there's so little I know about this topic. And if we want to make things better from a physician standpoint, we really have to understand some of these things. And uh that same when the panel ended, I immediately went up to Heather and said, Heather, can you please come on the podcast uh to talk about it? And uh so here she is. So, Heather, sorry for the very long monologue, uh, but uh I am so excited to have you. Thank you for coming on to the doctor's lounge.
SPEAKER_00Thank you so much for having me. It's so nice to be with you again. And that yeah, that presentation uh where we first met was quite enlightening to even those of us who were presenting. And just to hear some of the the pain that uh independent physicians are dealing with when they have to write those checks for their professional liability insurance coverage. It is disheartening. And yeah, I happen to work for a lot of institutions that employ physicians, and those institutions pay for those doctors' insurance coverage. So I I sometimes forget that there are uh physicians like you out there who are, you know, kind of uh rowing your own yeah, rowing your own boat by that's for sure.
SPEAKER_01All physicians are paying for it. It's a matter of indirectly or directly paying for it. And to be clear, I don't want to this is not a woe is me uh who're writing these checks. By the way, Dr. DeGiorgio, welcome. I I mean uh to the folks who are tuning in for the first time, Dr. Giorgio, my co-host, is a trauma uh neurosurgeon and at a teaching hospital, University of California, San Francisco. So uh very few people are doing uh what this guy's doing. And he texted me three or four hours ago saying I have three emergency cases. I don't know if I'm gonna make it. And I'm like, oh yeah, please focus on emergency spine. That's fine. And remarkably enough, he is he's here. I'm sure the robots that Elon has given you are finishing off your cases.
SPEAKER_03No, absolutely not. Everything went great. Um, but I think to your point about uh feeling the pain, employed physicians, I'm employed, and I'm fortunate enough to be on some uh committees where I get a look at the financials, and it's clear that the medical malpractice premiums hurt us as well. Our practice group uh has to pay out these premiums. Even if you're self-insured, you still have to pay out and set aside reserves for any uh any cases that come up. And so we certainly feel it as well. And they're looking at the cash reserve saying we can't give bonuses this year because uh we have to pay more malpractice premiums. We have a different case, obviously, in Pennsylvania. We have a different, a little bit different case here in California, but we just had microreform, which is making things more expensive here as well. So it used to be a pretty good state for medical malpractice, but now not not quite so much.
SPEAKER_01Yeah, so I thought I'd start with a case uh that has been kind of moving through the system over the last three years in Pennsylvania. In Philadelphia, actually. So April 2023, a Philadelphia jury returned a medical malpractice verdict of $183 million against the hospital, University of Pennsylvania. Penn is the largest academic health system in the in in the region. With delay damages, the judgment has now risen to $207 million. This is the largest reported medical uh malpractice award in Pennsylvania history. The case was appealed. The Superior Court affirmed this uh in July 2025, and now there's certain parts of the case that are going to be uh that have been appealed and have has been accepted by the uh Pennsylvania Supreme Court. I just published a Substack post on the case and the details of the case earlier uh today with a thread on X as well, kind of going through some of the pieces of the case. But I thought it'd be super instructive to go through this case and then use it as a launching pad uh for some other to talk about the larger ecosystem of medical malpractice and how it works. This was a as all of these cases are pretty tragic, tragic cases. The there's a 19-year-old, uh, never been pregnant before, who came in to the ER at around 11.30 in the morning. At around 1145, she was triaged, and at that point they noticed that, okay, she's pregnant, and uh her heart rate is 180, her temperature is 100.9 degrees, her blood pressure is elevated, and uh she's uh dilated. And they made a diagnosis of choreomnianitis, which is inflammation of inflammation, and this was based on her fever, the fetal tachycardia rates, and whatnot. So she started going down the pathway. Again, this is HUP, an academic health system, specialists everywhere, trainees everywhere, lots of lots of kind of eyes on this. Around noon, the attending physician sees her, makes a plan, uh saying that okay, if uh we're gonna try to do this spontaneous vaginal delivery, if not, uh think if things start to look sideways, we're gonna proceed to a C-section. I mean, this is a familiar this is familiar to physicians and anyone that's kind of been through the pregnancy process yourself or with partners. Ultimately, there's some question about fetal tracings and whether or not they are progressively getting worse or not. The interestingly enough, everyone who was there and the defense's witnesses all said that the traces appeared to be not emergent, not something that we necessarily need to be actionable right away. Of course, the plaintiff's expert says, no, no, these this was emergent. I looked at this and this was terrible and something, and you should have done something right away when you saw that. So there's a disagreement there. And but ultimately over the next few hours, she proceeds to go for a C-section because the baby appears to be in distress on the fetal, on the fetal monitor. So she arrived at 1145. Uh the baby is delivered at 236. I mean, this is really just you're talking about less than three hours. And uh at that point, um, the baby's not breathing, they have to do some resuscitative efforts, and and again, tragically, it it appears that the baby suffered a significant anoxic injury at some point during that process. And that's the case, that the case is three hours. Three hours, twelve, twelve jurors, and the the ultimate result was 187 million dollars, which again went up to 200 some million dollars afterwards. Heather, you're vastly experienced in this. Is this a pretty typical case in terms of what happens in terms of the amount of time and if there's a catastrophic event that happens, then you kind of work backwards.
SPEAKER_00So first and foremost, I had no involvement in this case. Uh, I haven't read any of the expert reports. I've read the the trial court opinion and the superior court opinion, so that's the sole source of my knowledge of the Hagen's case. The Hagen's case is very typical of the types of cases that we see. On the defense side, I guess, and probably on the plaintiff's side, we call them like they're bad baby cases. Something happens either prior to delivery or following delivery that the plaintiffs argue should not have happened or should have resulted in a more prompt delivery of the baby. A lot of these cases are driven by fetal monitor strips. Uh, in this case, I know there was discussion about the fact that this baby had a category two strip, which in my experience doesn't necessarily warrant uh going for an immediate C-section. And remarkably, I've seen these cases where you have a young mom, an 18 or a 19 or even a 20-year-old woman who comes in and has is pregnant with her first baby. And the physicians, if there is no clinical reason for them to do a C-section, they want the mom to deliver vaginally just because of the potential medical risks to the mom, uh, the extended discovery, uh sorry, the extended uh recovery rather from a C-section. And uh this case is a little unique in that it was such a short window of time that this patient was under the care of these physicians. And you can't know when a patient walks in the room whether that patient's gonna need a C-section. I mean, you're clearly monitoring mom and baby, and there was an article actually, I think a few months ago in the New York Times about fetal monitor strips and this idea of uh fetal monitoring and how it has resulted in such an increase in C-section. So, but this case is generally typical of a lot of the the cases that we see. Again, I wasn't at the trial in this case. I've read through it. There were some very unique things that happened during this trial, which are were out of the ordinary. The trial court judge uh defended her rulings in her opinion, and now we are obviously seeing this go through go through the appellate courts.
SPEAKER_01Yeah, there are so many interesting parts of the case. Uh and we have a lot of physicians who listen. So I do want to talk about the fact that at 2.05 p.m., a C section is ordered, the chief resident charts the indication as non-reassuring electronic fetal monitoring tracing. So that's what's charted, and that's what the plaintiff sees on saying, you know, non-reassuring, this is 2 p.m. and nothing happening until 2.36 p.m. And the chief resident was deposed. She explained that the reason she selected that was because that was the only pre-selected option in the drop-down menu. So category two tracing, which is the nomenclature that folks like using in these cases, and category two tracings are there's some things on it, they're not beautiful, but they're not also emergent and need to go right away. Exactly. That's why she didn't put category two, because the EMR would not give her a drop-down that said category two, and she's restricted to a structured data format of the EMR. So that's that, of course, is frustrating, and will a lot of our physician listeners will understand that part of it. The other part related to charting again is the chart records at 12.30 p.m. say that the nurse administered unison for the chorium amnionitis. Anesthesia note records the same medication, still infusing at 2.30 p.m. So if the dose went in at 12.30, it should have finished roughly at 1. And so again, the plaintiff sees on this as saying, aha, if the anesthesiologist is documenting that this is still infusing at this time, it must mean that there was a delay in the antibiotic actually going in. So there's that, there's that. Then there's the issue of the mechanism of injury in this particular case. So it turns out that if you have a what's perceived as a mechanism here is hypoxic injury, when there's a period of time where the baby is hypoxic, not getting oxygen, and after a certain period of time, there's significant injury to the to the brain. As part of trying the forensic investigation would be to look at the cord blood as the baby's being delivered to see what the acid-based status is of the cord blood. If the acid-based status of the cord blood, the arterial cord blood, is within a range that's considered normal for that, then it makes it extremely unlikely that hypoxemia is the mechanism of injury. And that's important because if this injury was, as Hupp attempted to say, due to inflammation from the chorium ammunitis, then the delay of the C-section, the C-section not happening the moment she arrived or within or earlier than she had it done, it wouldn't have mattered. There's no issues there. So that's a really important piece of it. And the fascinating thing here is that if you do have an arterial blood gas that's normal, then it really makes the mechanism being hypoxemia extremely unlikely. But the plaintiff's expert witness said, waved that away and said, Oh, no, they must have mislabeled it. It must have been venous, not arterial blood, because venous and arterial blood have very different pHs. And a plaintiff's attorney was kind of in shock and was and said, How wait, why are you just make saying that it it's Venus? I mean, where does that come from? You're just wildly speculating that it was Venus. The defense lawyer. Yeah. Right, the defense lawyer. Sorry, sorry, the defense lawyer, yes. And so lawyer for hub. And ultimately, it turns out that there's not, it's left in like limbo whether or not this blood gas sample is or is not. So this piece of evidence that would be like exculpatory or should be presented that way is just kind of neutralized by, well, it could be, it could be a different, it could be, it could have been mislabeled.
SPEAKER_00Well, what was more outrageous about that, though, was the fact that the trial judge wouldn't let the doctor who drew the blood to testify as to whether it was venous or arterial blood that was sent that was sent to be tested.
SPEAKER_01Right.
SPEAKER_00Right.
SPEAKER_01So Right. Right. Yeah. And again, it gets to the legalese of it. So the the attending physician was asked about the blood, and she was only able to get out one sentence about the fact that, yeah, I don't she basically said, no, I don't believe that there was any reason to do this right away because we didn't have any evidence that the baby was in distress, and a blood gas kind of shows that. And when the defense tried to come back to that to say, to talk more about that, to have her talk about, well, where did where did it come from, or did you witness it being drawn? Essentially the judge said, no, no, you can't you can't bring this up. You can't talk about that because this may be this is an opinion and not something that is a witness. I go into the details of that, of course, in the Substack post as well. But essentially that it was not fleshed out that with great certainty we can say that the cord blood was arterial. So there's a number of these things that happen. And finally, you get to the instructions that were given. And this is where Heather, I was super interested to hear her comments. The instructions that were given to the jury are written on something called a verdict slip. All right, please correct me if I'm getting any of this stuff wrong. It's a formal questionnaire that breaks the case into discrete yes, no, and damages questions. So the verdict slip is distinct from like the oral judge's explanation of the law and the jury that's given right before the deliberation begins. In this particular case, the verdict slip asked whether the hospital acting by and through, that's in quotes, acting by and through the named clinician was negligent, and whether the negligent was either a factual cause of the harm or increased the risk of the harm, uh increased the risk of harm. Under ordinary negligence law, a plaintiff must prove factual cause, that the defendant's conduct more likely than not cause the injury. Pennsylvania has this interesting wrinkle that is more plaintiff friendly, that is more friendly towards the person who had the injury. When a defendant's negligence increases the risk of harm that occurred, and that increased risk was a substantial factor, the jury may treat the negligence as a cause even without finding the classic but for causation. If you had done this, you would have done better. Just says, well, something that you did increased the risk. So it's an important point because it was set up, the verdict slip was set up as an or. Like, is there a factual cause? In which case that's a higher.
SPEAKER_00Right.
SPEAKER_01Right, right. It's a factual cause. Yeah. Not just not factual cause and it's it's a factual cause or increased risk of harm. So yeah, I've probably butchered that a little bit uh Heather, but could you uh kind of tell me about that? Was that striking to you?
SPEAKER_00It was, uh, because I've never seen a verdict sheet uh described in this way. First of all, going back to I want to just go back to a comment about the EMR and just anecdotally, you know, I remember when I started doing this work uh as an associate over 20 years ago and having to deal with handwritten hospital charts and handwritten ER charts and trying to decipher who wrote this note and if they would only just type their notes. And then lo and behold, during the course of my career, we now can't, you know, Epic came out, everything's typewritten, everything's time-stamped. And so it's they're gonna get you one way or the other. We either either you didn't document it, or you did document it, but you documented it late, or it it's just the EMR it uh has now become the bane of our existence because as a nurse, as a physician, we know that you cannot do something, you cannot provide medical care or treatment or nursing care and treatment and document it at the same time. It's just an impossibility. And so the uh the EMR is giving us a play-by-play of everything happened as it happened is just absurd. But that's what the plaintiff's attorneys have created as an illusion for a jury. They've basically kind of taken away the context of actually practicing medicine on patients and then documenting later on. Exactly. You get re repetition.
SPEAKER_03If you're a doctor on the stand, you're used to clicking through a computer screen and navigating and finding things that way, and they hand you this stack of paper, a PDF they've printed out that could be like 700 pages long, and you're flipping through it trying to find a relevant piece of information. And 99% of the stuff that's in there is completely irrelevant. So I think it's made it incredibly difficult.
SPEAKER_01No, but the crazy thing is, uh Heather, as you're saying, is that the simple impossibility of the EMR documenting exactly what you're doing, exactly when you're doing it, the fact that you have to take time out to then chart it, right? As good as you try to make it, you know, the anesthesia folks have some really nice thing and stuff, right? There's that time lag between doing that, right? And so it's not capturing things right as it's happening. So in that lag, that hole, which is systematically going to happen unless you literally had like, you know, somebody and AI. Yeah, ambient AI, who's ambient AI or some scribe who's just watching you and documenting exactly what you're doing, uh, unless you have that, you're not gonna have an actual record of what happened. And of course, ambient AI can make mistakes. So that incomplete record gives juries and motivated plaintiffs room to reconstruct some sequence in the light that's most favorable to them.
SPEAKER_00Exactly.
SPEAKER_01It's never the case that documentation uh you know favors favors the plaintiff, right? So uh favors the defense, sorry. So uh yeah, that's a pretty fascinating thing. But tell me more about this, you know, this idea of the threshold for finding fault, right? Because the jury here ruled against HUP, right? And it's like, okay, open shut, the jury ruled against hub. But but it's not that. The jury is given instructions, and that's what this verdict slip is, that says it gives them instructions because this is complicated cases. It's like, how do you figure, I mean, how do you take 12 random people off the street and are like, okay, who's at fault? No, no, they have to be led a certain way. And that guidance is exactly what we need to think about and talk about. And the verdict slip here said put basically set the threshold for the jury in a certain place. That they said you could either you could do either the lower threshold or the higher threshold. So if you say or, then you meet the lower threshold, then you're guilty.
SPEAKER_00So it's not you're guilty, it's you're liable in civil cases. You're liable in civil cases for money damages. So going back to just to kind of parse this out a little bit, at the con you sometimes at the beginning of the trial, the judge will actually read the jury instructions to the jury at that point so that the jury is understanding what the law is before they even hear the evidence. A lot of judges just wait until they've heard all of the evidence, and then the judge gives the jury the instructions on the law. So at that point, the judge is instructing the jury on what factual cause is and on what increased risk of harm is. Just historically, increased risk of harm came about from a lot of delayed diagnosis of cancer cases, but now it's being used in case. That really don't call for increased risk of harm. Like I had a case a year ago in which a patient who was a victim he was uh suffered a self-inflicted gunshot and there was an alleged delay in treating him in the emergency department. There wasn't, but the plaintiff tried to claim that that was an increased risk of harm case. And that really wasn't what increased risk of harm is about. In this case, I don't think increased risk of harm applied either in this case, although the the experts all came in and said it. I don't know what it was that they what backed them up on this increased risk of harm.
SPEAKER_03Sorry, and is increased risk of harm a Pennsylvania specific? Because I don't think I've heard that.
SPEAKER_00It may be, I don't know what other jurisdictions use increased risk of harm. In Pennsylvania, we have factual cause, but in certain instances when the evidence is there, a jury can be instructed on increased risk of harm. And again, that's typically a case where this patient had an abnormal finding on a chest x-ray two years ago and was never told to follow up and get a CT study of their chest. And then two years later, they're diagnosed with stage four lung cancer. Well, that doctor back in two years ago, two years ago, who didn't tell the patient to follow up about the abnormal finding on their chest x-ray, increased the risk of harm to that patient by letting that time go by where the patient couldn't seek out a second opinion or get that CAT scan follow-up. So that's where increased risk of harm came from. Not a case like this where a patient comes in and in three hours delivers a baby because she has essentially an infected placenta. That's what choreoamnionitis is. The patient had an infected and inflamed placenta where the baby lives, that the organ of the woman's body that provides the baby all the oxygen and nutrients that baby needs to survive, that organ became infected. And Heather, explain I don't think there was any evidence in this case. I didn't see any, other than the experts testifying that there was an anoxic brain injury caused by the delay in delivery. I didn't I didn't see that in reading through either of the opinions.
SPEAKER_01Why would that not be a factual cause of harm in the example that you gave about the uh a clinician that does not recommend uh follow-up for some abnormality on chest x ray, and then two years later the person has uh lung cancer? Because isn't it the case that like but for the radiologist not or not radiologist, whatever, the clinician not contacting that particular patient. Can you help me out with that? What is the I still don't get the real distinction between the two. Why are they both applied?
SPEAKER_00It's just I think the increased risk of harm was an evidentiary decision that was uh established here in Pennsylvania so that plaintiffs could, in some cases, have an easier time meeting their burden of proof. It makes it easier for the plaintiff to meet that burden when it would sometimes be difficult to say, well, that failure to did that failure to recommend the CT scan cause the patient's lung cancer? Or did it increase the risk that the disease was going to spread over the course of the two years that the patient wasn't actually getting treatment or follow-up for that? Right. Right. Going back to the uh verdict sheet, uh, what was also unusual in this case was that, and I read the trial court's opinion about this uh constant reference to the team of doctors and nurses and this team concept that was talked about throughout the trial. Again, I wasn't at the trial. In the verdict sheet, first of all, defense counsel acknowledged that the doctors and the nurses who were involved, uh, who had been named as defendants were employees and agents of the Penn Health system. However, that doesn't necessarily mean that a team theory of liability was adopted by defense counsel. I think what should have happened on this verdict sheet is that there should have been separate questions for each individual defendant. So if it was, okay, we're going to dismiss all these individual defendants and just have Hupp on the verdict sheet, it still should have been, the question should have been, was Hupp negligent buying through the conduct of this individual for the alleged negligence? And then break down by each individual that question. Whereas in this case, I think the jury was uh presented with a question of was Hupp buying through its agents and then named each of them. So there never had to be an establishment of uh any proof against each of the individual providers who were providing care to this patient because of this theme, I guess, throughout the trial that it was a team approach. So that's unusual. That's very unusual. And I think that's gonna get reversed.
SPEAKER_01Yeah, I realize that I messed this up in the post actually. So the plaintiff's counsel in I forget, what is the venue when plaintiff and defense talk to the uh talk about what goes on the verdict uh slip?
SPEAKER_00The charging conference?
SPEAKER_01Yes, the charging conference.
SPEAKER_00Yeah.
SPEAKER_01Yes, right. So this charging conference is the judge and the two lawyer teams, correct?
SPEAKER_00Correct.
SPEAKER_01And that's very important because you're deciding what goes on the verdict slip, reiterating what you're saying for the audience. There's this idea that the hub team, the question was, was the hup team not up to bar? Not was each individual member of the team where did they fall apart? And so defense uh for hupp said, hey, we want exactly what you just said, Heather. Uh, we want a verdict slip that says each member that's sued, and tell us did they fall below whatever standard of care, right? And in the plaintiff's attorney's own words, I'm says, I'm in a catch 22. I'm quoting, I'm in a catch 22. If they want to list every individual and say what Dr. Leitner, Dr. Leitner was the attending, what did Dr. Leitner do? The answer is nothing. If you look at the record, she did nothing other than testify that she did everything right. The same thing with the nurse. There's no documentation of anything. Because again, Dr. Leitner saw the patient and then went and then saw the patient again in the OR. So what did you want Dr. Leitner to do? So so then she goes on. What we are saying is this whole team on this day failed this patient. And that is all under hup. Because we can't point necessarily to any individual because there's a complete lack of evidence. So so the plaintiff counsel themselves is admitting in this charging conference. I said in closing, that's wrong, in charging conference, that that the case could not be proved against any identifiable clinician. So the verdict rests on this collective failure, uh and this collective failure of the team.
SPEAKER_00Which is not a theor a plausible theory in Pennsylvania.
SPEAKER_01Okay, right. So that's right. So anyway, that's an important piece of why it is the jury found the way the way it found. We've talked about the cord gas and how a part of it was also based on kind of these legal evidentiary standards not allowed. We've talked about the documentation with EMR and the gap and the fact that the chief president literally says, I can't put down category two tracing because that's not on the drop-down. I can only put not reassuring. Anthony, there's a research uh paper in that.
SPEAKER_00But yeah, I think there there needs to be some some better beta testing with EMR dropdowns.
SPEAKER_03Yeah. Don't get me started.
SPEAKER_01Come to about uh let's spend a little bit of time on how that $207 million case, how you come to that number. The jury award broke down as $101 million for future medical and life care costs, $80 million for non-economic damages, the life care component. So there's actually professional life care folks who try to estimate what the cost of care would be for an individual with this type of injuries over the course of their life, right? Over the course of their life is an extremely, you know, how do you decide what the average life expectancy is of somebody with severe cerebral palsy? Some people. In this particular case, uh the defense pediatric neurology expert projected a life expectancy in the range of age 29, so about 29, 30 years. The jury somehow selected a life expectancy of 70 years. And so some of the reasons why this number is so large is because if you compound medical care costs over 70 years versus 30 years, I mean, that is a really, really big difference. So can you tell me a little bit about why it is juries have this ability to do it? By the way, it's not just, it's not, I mean, the the Superior Court affirmed the right of the jury to listen to two experts and and pick 70. So Heather, tell it, explain, explain that.
SPEAKER_00Based on my reading of the opinion, I understood that the plaintiff's expert never actually offered any life expectancy opinion, I think, with regard to this child. And I it's my understanding that the uh plaintiff just put on like a life table showing that this child had a life expectancy of 70 years. And that the defense did put on Dr. Mince, who said that this child had a life expectancy of until approximately 29 years. I suspect that the jury just decided they didn't want to believe Dr. Mince and believed the fact that they, you know, I don't know how Dr. Mince was cross-examined on that issue regarding li life expectancy. There are some people who just in their lives they're exposed to people with cerebral palsy, and maybe they've been maybe so-and-so's son was told they were told he would only live until he was eight years old, but now he's a 40-year-old man. So I think that those practical life experiences that people come into the jury room with sometimes dissuade them from believing uh a pediatric neurologist, as well credentialed as Dr. Mince, who says, I really think that this child with the severity of his injuries is only going to live to age 29. And then in terms of the the vocation, the uh life care planners, they of course put these huge numbers on their future life care needs that this child's going to need either a facility to provide care to him or her. I don't remember if the child was a male or female, but they're the life care plans are big number plans typically, for especially for these bad baby cases. It's not unusual for us to see life care plans over $100 million, even though the reality is we know that this child is being provided for, very well provided for uh by all the governmental services that are available to that child. And so the jury doesn't hear that. The jury doesn't hear that, well, this child's been getting Medicaid or whatever benefit. They've been getting Social Security benefits, they've been getting all the early intervention and all of those sources and supportive uh sources that are available to children with disabilities. The jury doesn't hear that. They don't hear that there is a lien that has to be paid back. There might be a Medicare set aside that has to be established. So again, a lot of juries, in my experience, sometimes they're more interested in what they haven't heard and will ignore evidence that's presented to them and think things up on their own. Last year there was a trial in which the jury, nothing ever came up during the entire trial about the nurses who were present at the delivery and who recorded a baby's ap guards. And yet the jury questioned why they never heard from those nurses. There was never actually an issue regarding the baby's ap guards. So jurors tend to focus on sometimes what they don't hear more than what they do hear. And I don't know why that is.
SPEAKER_01It's kind of sounds like the IDR uh arbitration, Anthony, right? It's like 29 versus 70, and you're like, oh yeah, we'll pick 70. Uh, but it's a little concerned. I mean, the Heather brings up some excellent point. It's not that there isn't care. I mean, this has been going on since 2023, I think. Or no. The case started in 2023. So I think the child is eight years old now. So the child has been receiving care. And the question is, okay, the child is receiving care. Do you need $100 million on top of that? The other, of course, was the economic, the non-economic. So there's economic damages that come from the life care plan in terms of what the cost of care will be. The other is the non-economic award of $80 million. That was also very large. And plaintiff's counsel, by report, referenced Philadelphia Eagles quarterback Jalen Hurts, uh, who had just signed a $51 million annual salary and invited the jury to consider what a lifetime of profound impairment was worth by comparison. Why would uh uh they do that, uh Heather? Why would they bring up the star Super Bowl winning quarterback salary in a closing argument to the uh jury?
SPEAKER_00That's a popular strategy called anchoring that a lot of plaintiff's attorneys use when they're presenting evidence to a jury and in this case making a closing argument. Unfortunately, as I read the opinion, apparently there was no objection when that comment was made. And it was just trying to kind of throw a number because they're not supposed to be able to ask a jury to award, you know, please award my client $200 million. They are not allowed to do that in Pennsylvania. Now, there is a bill currently going through, uh, I think it's gone through the House. It might be on through the Senate now, I'm not sure, which the plaintiff's bar is trying to get that permission to say to a jury, we would like we're asking you, jury, to award our client $100 million. And so that's currently under review. That may be the next unfortunate route that medical malpractice litigation takes. But certainly saying something like, Well, Jalen Hurts makes $51 million, to put that into perspective. Look at this child, look what he's going to need. You know, he could have been the next Jalen Hurts, but he was robbed of that opportunity because of this injury at birth. So it's that whole concept of making a jury think that's a number I can kind of hang on, hang my hat on to. And keep in mind that these these large life care plans that are being presented to juries, I mean, at the end of the day, it's really all about money. And it's really all about how much money the the plaintiff's attorneys are going to make. I mean, forty percent of a two hundred million dollar verdict is a lot of money. So I though it it would probably be subject to thirty-three and one-third percent in Pennsylvania for a minor's case.
SPEAKER_03But you know, that that's how much the commission is on those?
SPEAKER_00I I man, I think the contingent fee agreement for a minor, I think by legislation, it's thirty-three and a third percent. But all other cases, if if you've yeah, it's typically forty percent. Wow.
SPEAKER_01Wow. I had no idea it was that high. And so there's a bad effect of this downstream, right? And I just want to reiterate that uh this is not an obvious like we want as physicians, this is not like, oh my god, we don't want any single person to recover damages for something horrendous that happened. The thing that's the reason this kind of sticks in my craw and it'll stick in other physicians' cross, and it should stick in the public's craw as well, is that this is not an obvious case. I mean, ACOG, right, the American College of OB obstructive uh gynecology, they have guidance on intraamniotic infections. And the current guideline says, in quotes, intraamniotic infection alone is not an indication for immediate delivery. And the route of delivery in most situations should be based on standard obstetric indication. So good clinical medicine is not taking every single person who has a suspicion of inflammation of the amniotic sac and planning delivery for that, right? Uh category two, fetal tracings, which is what multiple people, the people on the ground thought this baby was having, are by definition indeterminate. Management calls for evaluating the full clinical picture, intrauterine resuscitation, surveillance, and only if then things go bad, then doing something. And there's a reason for that, right? There's a reason for why that is what the guideline is. So you basically are taking a case where there's a bunch of gray, where it really does come down to the decision makers that are on the ground in terms of what they're seeing, whether or not they want to pull the trigger on something or not, and uh basically making that malpractice. And I think that has some really serious implications, especially when you have a verdict that's this large that comes down the pike, right? Because it's not just the hospital's balance sheet or the physician's malpractice premium that I think is the main focus here, right? The question I want the public to understand is that when the next pregnant woman arrives at an LD in Pennsylvania with suspected chori amnionitis, do you want them to be offered a C-section right away because the Obi-Guyne is thinking about this case and that, oh my god, if I don't do this right away, that and something happens, I'm gonna end up being embroiled in some five, six-year lawsuit? C-section.
SPEAKER_00The likelihood is that even if that doctor did do a C-section and that baby suffered injuries as a result of the choreoamninitis, there's still going to be a lawsuit because there's no winning.
SPEAKER_03There's no winning.
SPEAKER_00There is no winning. Because I have been in so many depositions where doctors and nurses are uh basically taken to task for things that they did, and now they're being taken to task for things that they didn't do. And when their testimony is there was no clinical reason to do what you are suggesting, there are actually experts who have been hired and are willing to come into court and testify on behalf of the plaintiff to say exactly the opposite of that, that even though this patient didn't have any clinical, clinically significant, anything clinically significant that warranted a C-section, or clinically significant that warranted magnesium sulfate, or clinically significant that warranted taking the patient immediately to the OR, they're gonna say, well, you should have done it anyway. You should have done it anyway. And I think that that causes physicians and nurses to have to start practicing defensive medicine and focusing on their documentation instead of the care that they're actually providing. And that's one of the biggest downsides. Trevor Burrus, Jr.
SPEAKER_01And there's a there's a downside to do doing lots of things, right? I mean, there's a downside to ordering a well, I mean, in this particular case, when it's a procedure, there's even more downsides, right? I mean, as we talked about earlier, there's a downside for taking a C-section first approach that could cause more net harm. If you take a thousand women and you are doing C-sections much earlier than normal because there's this, they're thinking about this case. Um, and yes, of course, something bad happens, something bad happens as a complication of the C-section, then now there's another lawsuit because of that. And then the question becomes, well, doctor, it was a category two tracing. You know that category tracing doesn't mandate that you do something. Why did you do something then, right? I mean, but then until that $100-200 million dollar case comes down the pike, then you know it'll be this constant pendulum where it's scary because then it's not the clinicians that are making decisions based on what's the best thing for the patient. It's the clinician making decisions based on what they perceive at the moment will least likely end up in some massive, massive verdict that, of course, every every malpractice suit for physicians, if you get an award that's over your individual, you know, MCARE plus individual malpractice, hey, they can come after your house, they can come after your personal assets, right? That's the reality for every physician.
SPEAKER_00I think the physicians who are out there by themselves who don't have a health system behind them, I think that's their reality, that they have to be concerned about that. I mean, I don't think too many plaintiffs' lawyers want to go chasing down and forcing a physician to sell their home or to sell their car necessarily to pay off a judgment. They want the money up front and they want the deep pocket. And if the deep pocket is the hospital or the health system or the physician's employer, then so be it.
SPEAKER_03Then I think a lot of times those doctors working for large health systems, that's one thing going towards consolidation. But at the same time, the defense for the large health system may not always have the individual doctor interests at heart, right? Because there, whoever the large health system hires is defending the health system, not the doctor, and sometimes may settle in a case where a doctor may, if the doctor was individually liable, may actually want to fight that case. At least that's I had some colleagues where that's happened too. Do you agree with that?
SPEAKER_00I've seen that happen. I've seen where the the doctor definitely doesn't want to settle the case and and wants to defend his or her care at trial. But, you know, they're uh with a lot of these health systems, they're providing the professional liability insurance for the physicians. A lot of those policies don't require the physician's consent. Right. So you've got to be able to do that.
SPEAKER_02And they they they may want to avoid publicity too.
SPEAKER_00Exactly. Exactly. They definitely want to avoid anything that's bad publicity, and you'd be amazed what's out there in the healthcare system.
SPEAKER_01Yeah. Yeah. And then beyond the f individual physician and altering how they practice in a way that's bad for patients, there's the fact that, like, okay, maybe Penn and Jefferson can survive one of these every X number of years, but they're small regional health systems, regional community hospitals cannot. So what planet would say? I mean, I don't think there's a I don't have a problem naming one, but why would Methodist Hospital, which is a small community hospital in South Philadelphia, why would they, if they were independent, why would they continue to offer over They're gonna say, heck no, like go spend another 15 minutes going to Jefferson and let them deal with it. So yeah, you are overall, if we don't get the system to make sense from a justice standpoint, to be fair, then you're gonna have downstream effects that are definitely negative. So you're talking about delays right now at a place like Penn. Okay, if the only places that deliver our are our main satellite centers or sorry, are the hubs of these large health systems, how long, how what do you think is gonna happen to the amount of time that you have to wait to get a C-section then? Really, really problematic, I think.
SPEAKER_03So Can I ask I I'm fascinated with New Zealand's medical liability system, right? So they essentially have a no-fault liability system. And I think Florida for OB followed suit where uh you essentially separate the uh the compensation portion from the fault and punishment portion if there's an injury. And because the you know, Florida, it was getting so bad because the lawsuits were so horrendous that it was it was severely affecting OB care. And so what they did in Florida was essentially carved out OB into this no fault, and someone can please correct me if they have more details on it. But it was essentially there's a fund that if there's a birth injury, you just get paid out of this fund, and the fault uh is is not assigned to the specific physician, and that they leave it to the medical board. And so New Zealand essentially does that for all medical malpractice. You can still sue, uh, but basically, if the system over there determines that there is uh or that there is a harm has been done, you get paid out of this fund. And then the the punishment and the and the the fault actually is a totally separate mechanism that's handled through like the medical board. So I'm just fascinated by that system. I don't know, Heather, if you have any insight into it or or the Florida system, but I I see that as as maybe a way to solve this mess.
SPEAKER_00I don't I am not familiar with either New Zealand or the Florida system. Uh the Florida system almost sounds to me like it might be something. It doesn't sound to me like I think there are too many plaintiffs' lawyers down in Florida to allow uh that to be the the new process by which victims of malpractice are compensated. I just don't I don't think that's the thing.
SPEAKER_03It was just for OB, though, just because they were they were having such a shortage of OB uh from all the judgments that they carved that out for just a birth injury fund. Right.
SPEAKER_00It's interesting. So uh I'm just wondering like sometimes it almost sounds as if I what I thought you were going to say was that they've chosen to bifurcate the issue of liability and damages. So that's you know, certainly something that I think there has to be some consideration given to in those cases where you've got really bad damages, but maybe not that maybe the liabil the liability is not so clear. But I think juries are they're human, they're going to be sympathetic. And, you know, they see an injured child come into a courtroom like they did in the case against Penn. And it's hard to set aside a picture of this injured child from what you're hearing. So if they had just had to decide the issue of was there medical negligence without hearing anything about the damages, would this outcome have been different? And then if they meet that initial question of yes, the doctor was negligent, yes, there was causation, then maybe a separate trial on damages. Uh, I think that obviously it's taxing on judicial resources to do things that way. Uh, I think with the right case, though, if the damages are so inflammatory, or if there are specific facts in that case that would invite a bifurcation, that's potentially uh what could be done. Yeah, I just uh I think part of the problem is that the these types of verdicts, the verdict in 2023, the verdict most recently this year in March of 2026, which was another significant verdict that, you know, we haven't used the word nuclear verdict. I know several people who hate that term. I hate the term. It's just an unreasonable verdict based on what we know uh in handling these types of cases. But I just don't think it's sustainable in the long term, even for a place like Philadelphia, even for a a health system like Penn, a health system like Jefferson, a health system like Temple. So many of these health systems are serving underserved communities and uh Temple for sure. And I don't think that uh getting hit with these kinds of verdicts on a, you know, even if it's every three years is sustainable, especially if they're upheld.
SPEAKER_03Can I ask about experts? Uh it seems to me that a lot of this, a lot of these judgments uh really do rely on getting an expert to say something to back up the plaintiff's case, right? And if you can't find that right expert appropriately credentialed to say the thing you want them to say, a lot of the times the case may not or may fall apart. But we've seen experts just kind of hand wave, like you mentioned before, they'll hand wave away facts, or I've witnessed some really, really stretch the truth, the bounds of truth, really, really stretch things, medical plausibility to things that first-year med students should be able to call them out and say that's completely false. As a neurosurgeon boarded by the American Board of Neurological Surgeons, if I do that and it gets back to them, I can have my board certification taken away. But beyond that, there's really no recourse. Is there any recourse that you're aware of that could maybe make experts behave in a more rational, you know, moral method and not stretch the bounds of truth just to get this paycheck from uh a plaintiff attorney?
SPEAKER_00I've heard from some doctors that I've represented in the past whose cases have gone to trial, that they sit there in absolute frustration and disillusionment and disbelief that one of their colleagues is taking the stand and testifying contrary to I've been there in that situation. Yeah. And so they've said, I intend to report this doctor to the the board, you know, following the trial. I don't know what the boards do with that. I think that's the problem, is you can report to the neurosurgery board or the ACOG or whoever, what does it do? What do they do? Do they say, well, this doctor has a First Amendment right to come in to a courtroom and testify however he or she sees fit? I think a lot of boards do take that position. Other times I think it's if there an expert comes in and testifies at trial against every kind of concept that we know to be true in medicine, and they take the exact opposite approach, and the jury fines for the plaintiff, then if that doctor is reported to the board, the board says, Oh, well, you're just a sore loser because they found for the plaintiff. So I don't know the answer. I do know that our juries are getting in Philadelphia are getting younger, uh, they're smarter, uh, a lot more diverse, a lot of women on our juries. And I spend a lot more time thinking about who I want as an expert in front of those types of juries. I'm looking a lot for a lot more female experts than ever before, uh trying to find experts who are well credentialed and deserve to be called an expert, but who don't look like they just graduated from med school last week. But you also don't want I personally don't want that 80-year-old expert on the stand either, because I'm always concerned about how a young Philadelphia jury might relate to that expert.
SPEAKER_01So Heather, don't you think that just like you have the verdict slip and that this type of like very uh specific guidance, don't you think that uh we need to have guidance as it relates to things like economic damages? Because it's a multi-part problem, right? I mean, I of course one part relates to there are things that can be done. Like for instance, let's talk about the fact that legislatively the venue selection in Pennsylvania was dismantled. The venue selection, uh the venue was uh carve out uh where you weren't allowed for some period of time to take a case that was that happened in, say, Lancaster, Montgomery County, and then move it down to Philadelphia just because you wanted to, right? The injury had to happen somewhere. It had to happen in the in wherever it is this was this was taking place. And that's because Philadelphia juries uh have traditionally been, you know, extremely generous for whatever reason with regards to their verdict. So once you had these health systems kind of spawn and go everywhere, where place like Jefferson Health System has like all the way up to Allentown, Lehigh Valley Health System, now suddenly you had legislative action that said, okay, if the health system is in all these different places, you can move it to somewhere where the health system is. And of course, that place would be Philadelphia. So it's almost like the rapid expansion of health systems everywhere kind of made them, made them more vulnerable to these kind of verdicts because you could move something from out in the community down to Philadelphia. So that's one, and you could, of course, legislatively try to reverse that, correct? The other thing is not legislative.
SPEAKER_00I think only the Supreme Court can reverse that, that venue rule that was in place temporarily from I think 2003 or so up until um about three years ago. And of course, um we saw what happened as a result. The numbers did go up, a lot more filings in Philadelphia. Certainly uh my caseload, most of my caseload is in Philadelphia. I used to have it in the five county area, but now it's primarily focused in Philadelphia. And yeah, it used to be that you could only sue where the uh care was actually provided in the county where the care was provided. And so it it it's unusual to have a case where all the medical care and treatment happened out in Chester County and have that case presented to a Philadelphia jury. I think it can go either way. I don't always think that choosing Philadelphia for a Chester County case is the right decision because sometimes these Philadelphia juries aren't going to be relate, be able to relate to that plaintiff from Chester County, depending on what part of Chester County they live in. So there are strategic decisions that have to be made all along the way.
SPEAKER_01And well, that's partly why we can't leave it up to like I mean, it it's just to me it's silly that we have to like think about who is the expert who will most identify with the young jury. I mean, these are medical cases. This is this is this is something that is needs to be much more objective, much more science-based. So you need to have, for instance, uh just as we're talking about experts, right? We could be much tighter in terms of who we allow to be to be experts. Um we could have like the life care stuff, right? I mean, if you could have you could have legislation or something that that binds you in some ways and gives you guidance about how to come up with come up with these these estimates. Like the idea that we just have economic damages that are just unbounded and it's like, okay, you can choose 70 for somebody with severe cerebral palsy, I mean it it it's ridiculous. I mean that that that just doesn't happen.
SPEAKER_03I mean, uh you know, well that that's why a lot of states cap it. All right. There there are many states that have caps, at least on non-economic damages, right? Right. Right. This is economic damages I'm talking about. Yeah.
SPEAKER_00In preparing for trial, when we are dealing with these life care plans that are astronomical and not based on anything in the record, and you we file these motions to preclude like this child has never had X, Y, and Z, and yet this life care planner is saying this child needs X, Y, and Z. That should be precluded because there is simply no basis for that opinion, no foundation for that opinion. The court always comes back and says, Well, Ms. Tureshko, that's for cross-examination. That's for cross-examination. No, the jury's gonna hear it. You can cross-examine the expert. So that's what happens is the cat, the horse is out of the barn. I mean, they've heard it. And then, you know, to I'm doing my job cross-examining the life care planner about the fact that this child didn't need this. But, you know, the jury's depending on it's a lot of it is a personality contest, whether they they like the the very enigmatic plaintiff's attorney who's putting his case on and entertaining them. There's a very different jury in that they have a very short attention span. So they want facts kind of thrown at them very quickly. And I don't know that they're spending the time that we need them to spend really digesting this medicine and understanding the medicine, and then sitting there and deciding, was this doctor really negligent? Did this cause this baby's harm? So it's a challenging environment that we live in, and I don't see it becoming any less challenging anytime soon. I do think that the plaintiff's bar is much more uh well-equipped and well-armed legislatively.
SPEAKER_01So what would you say? What would you say to physicians who wanted to get organized and say, okay, what are the things that we can get behind that aren't gonna be isn't gonna be some 10-year time frame that requires some type of PA constitutional amendment? Like, yeah, I think what would you say like the three or four things are that we could all get behind? Because for this for for physicians, regardless of what you think about affirmative action or Medicare for all or or whatever, because physicians uh you know will divvy up on all of those lines and get into fisticuffs. Anthony is constantly in the comment section uh arguing with people about uh all sorts of things. But the thing that we and uh Anthony and uh folks that are on the on every side of the political aisle can certainly agree on is this issue. Is this is a 99-1, not a 90-10, a 99-1 issue for physicians. What can we do? What can we ask for from a state from a state standpoint? And I don't know what maybe what can we ask for from a federal standpoint?
SPEAKER_00Aaron Powell I don't think you can ask for anything from a federal standpoint because I think ultimately each you know, this is state law. This is always going to be, it's it's gonna be dictated by the state in which you live. I think lobbying, you know, creating a lobby. The lobby for what? A lobby for physicians who want to practice without fear of constantly being sued, who but what specifically can we s can we lobby for?
SPEAKER_01Like like what should we what say there's a group of fifty of us that are able to raise some money and and create a create something, what would we go to our local congresspeople, whether it be Republican or Democrats, and say, hey, this is what I want you to do?
SPEAKER_00So perhaps it's perhaps it's a cap on damages. Although I I think that the the plaintiff's bar is so well armed, it's unlikely that we we would ever see a cap on damages in Pennsylvania. I mean, right now there is a $250,000 cap when you sue the state of Pennsylvania, and that has not been undone yet, but there are efforts underway to try to to overturn that. I think really kind of tightening up expert qualifications. There it's basically a free-for-all, or what I call the Wild West sometimes when you go over to City Hall to try a case, and you think there's no way this expert should ever be permitted to testify for the plaintiff in this case because he's not qualified, he's not even the same board certification. But the rules give the judges so much discretion and you know, frequently absent an abuse of discretion, the superior the appellate courts are going to uphold the trial court's decisions. So I do think that the defense just needs to become more organized, more legislatively active, or as active as the plaintiff's bar is. The plaintiff's bar has the Pennsylvania Association for Justice, I think it's called. They're basically, I think, a lobbying organization across the state for the rights of victims. And, you know, I absolutely agree that when somebody is harmed by someone in the medical profession, that they are absolutely entitled to compensation and should be made whole again. The problem is too often we're seeing just an exploitation of the medical care that's been provided or an exploitation of really the health system. And I don't know what the answer is. I've thought about this because I knew you were going to ask me this. I don't know the answer. I don't, but I do feel like every decade there seems to be something that catapults us into trying to think how we can make changes to better our judicial system so that it's more fair to not just the victims, but also fair to the doctors who work hard and are here not intending to cause any harm, but they're here to provide care and treatment. I mean, no one spends as much time as you guys spend going to medical school and going through residency training and doing what you do to intentionally harm people.
SPEAKER_01So tight so tightening up for take something simple like tightening up what experts can do that. What does that take? Does that take a bill? Does that and that and then does that bill in Harrisburg does that get passed by a simple majority? Does it need a two-thirds majority? Walk me through how that like how that would happen.
SPEAKER_00So so that's a little bit out of that's out of my bailiwick. Um I what I can tell you is that I think the way the MCARE Act was passed back in 2002, I think there was somebody who sat down, decided we needed to rein things in to make Pennsylvania less of a place where make it more of a place where doctors want to actually stay in practice because there were so many physicians who were leaving the state. Uh obstetrics and neurosurgery and orthopedic surgery. Whenever I would represent residents in those three fields, I would say it's not a if you stay in Pennsylvania, it's not a question of when you're going to be sued, or if if you're going to be sued, it's a question of when you're going to be sued, especially if you stay in Philadelphia.
SPEAKER_03Um, natural end.
SPEAKER_01Excellent. Well, uh we had a really, I don't know, what we thought, Anthony. It was a g good conversation, right, in terms of uh trying to sort out what to do. But yet it does show the difficulties. Like, you know, it's hard to sort out what exactly to do and how to actionably do something. But but I think there's definitely clearly a crisis which we kind of are heading towards in terms of these very large verdicts and what's gonna happen to malpractice premiums and just the desire for people to practice is going to result in some type of uh that's gonna create its own pushback, and that pushback I think needs to be organized, and hopefully folks like Heather can help us uh help us do that. So anyway, well I'm super happy that you were able to get on. Everyone okay?
SPEAKER_03Everything's great. Everything is great. Glad I could make it as well. Excellent.
SPEAKER_01All right. Well, thank you again, everyone, for uh logging in and uh we will uh see you folks next week. Thanks again. Thank you.