Live Presentations > Topics
Dr. Cotton has spoken on virtually every medical-legal issue that physicians face at the bedside. The following is a list of the more popular topics. If you are interested in a topic that is not listed, please contact us.
Avoiding Delays in Diagnosis
Delay in diagnosis is the most common allegation made in the course of medical malpractice litigation. Minimizing the risk of this occurrence depends on physicians knowing when they become responsible for a patient and how far that responsibility goes. This presentation provides a framework for answering those questions. In part, it is based on a paper Dr. Cotton had published in the American Journal of Cardiology.
Managing Patients Who Decline/Refuse Medical Care
Patients who decline/refuse medical care place themselves at increased risk of a bad outcome and thereby create legal concerns for the involved physician. This presentation discusses which patients can refuse care, the types of care they can refuse, and how physicians should respond when they do so.
An Epidemiologic Approach to Medical Malpractice Lawsuits
In order to reduce the risk of a medical malpractice lawsuit, we must understand how they arise. Unfortunately, traditional risk management has attempted to explain lawsuits by focusing solely on physician conduct. While physician conduct is relevant, lawsuits can be better understood by taking a patient-centered approach and recognizing that certain risk factors make some patients much more likely to sue. This presentation reviews those risk factors and discusses how this approach should be incorporated into our risk management efforts.
Medical-Legal Aspects of New Drugs and Devices
New drugs and devices move the practice of medicine forward, but they also create medical-legal concerns and questions. For example, when does a new drug become the standard of care? How many potential risks should be discussed with the patient? Is it permissible to use a new product in an off-label manner? And, what is a physician’s liability in the event of a product recall or the discovery of a previously unidentified risk? This presentation will provide practical guidance on implementing new technology in a medical-legally sound manner.
Principles of Effective Co-management
Because most patients are managed by more than one provider, physicians must work cooperatively in providing care. Unfortunately, this increases the risks miscommunication and misunderstanding, which can compromise care and lead to allegations of medical malpractice. This presentation discusses co-management from a legal perspective and outlines the principles that determine physician responsibility in various situations. The overall goal is to provide an approach which allows physicians to efficiently co-manage patients in a medical-legally sound manner.
Becoming an Effective Expert Witness
Being an effective expert witness requires an understanding of both the legal process and the needs of the involved attorney. This presentation provides practical guidance on delivering a medically sound, expert opinion in a manner that will satisfy either the plaintiff or defense attorney. It also includes suggestions on effectively interacting with those attorneys and avoiding mistakes that are commonly made.
Understanding the Legal Process
Many physicians experience anxiety with being a defendant in a medical malpractice lawsuit. The anxiety arises from numerous unknowns about the legal process, including the risk to personal assets and the possibility of an entry in the National Practitioner Data Bank. There is also the disappointment of having another physician testify against us. This presentation puts these issues into perspective and provides physicians with the knowledge necessary to quell their anxiety.
Minimizing Medication-related Malpractice Risk
The traditional approach to reducing medication-related malpractice focuses on general issues that apply to all medications (e.g., good hand-writing and identification of allergies). Although these issues are important, the data shows that the most medication-related lawsuits are caused by a small number of medications that pose unique management challenges. In order to reduce the number of medication-related lawsuits, we therefore must focus our efforts on these particular medications. This presentation provides insight into how we can do so.
The Medical, Legal, and Ethical Aspects of Apologizing for Medical Errors
In recent years, disclosing medical errors to patients and apologizing for those errors has emerged as the dominant risk management theory. The approach is said to be good for everyone, ethically sound, and effective at reducing lawsuit risk. In fact, none of those things are true. The approach is unsupported by the medical literature, discounts the fact that many patients do not want to know about medical errors, and increases the risk of legal action from multiple different entities. Of greatest concern however, is that the strategy uses feigned emotion to psychologically manipulate injured patients out of their legal rights. This presentation discusses the origins of the apology movement, describes why it is supported by both plaintiff and defense attorneys, reviews the data related to its efficacy, demonstrates the pitfalls in the various medical apology laws, and discusses the ethical problems that feigned apologies create. In part, the presentation is based on several papers Dr. Cotton has authored on this subject.
Legal Aspects of End-of-Life Care
The key to understanding the legal aspects of end-of-life care is recognizing that the patient holds almost all of the legal rights. This presentation outlines the nature of those rights and provides guidance on how they should be managed in end-of-live situations. The role of living wills, powers of attorney, family discord, and withdrawal of life-sustaining care will be discussed.
Defining the Standard of Care
The central question in almost every medical malpractice lawsuit is whether the involved physicians delivered the standard of care. The problem is that few physicians have a good working knowledge of how the standard of care is defined. This leaves them in a position of trying to deliver something that they cannot define. This presentation brings clarity to this concept by demonstrating how the standard of care is defined in a variety of situations, including patient non-compliance, lack of insurance coverage, and conflicting or absent medical literature.
Legal Considerations with “Medical” Marijuana
Approximately half of the 50 states have legalized marijuana for medical purposes. To control access, the laws require patients to obtain certification from a treating physician. Physicians thus function as “gatekeepers.” Unfortunately, this places those physicians at significant legal risk, including the possibility of prosecution for committing a federal crime, the indefensibility of any resulting medical malpractice lawsuit, and the likelihood that involvement with marijuana voids the physician’s medical malpractice insurance.
Legal Aspects of Pain Management
Because it regularly involves the use of controlled substances, pain management is associated with a broader range of legal concerns than any other area of medicine. This presentation outlines the medical-legal principles of pain management and then demonstrates how various physicians have run afoul of those principles. The overall message is that the proper practice of medicine should be the clinician’s primary focus.
Regulating Telemedicine and the Violation of Physicians’ Constitutional Rights
The use of communication technology is an integral part of modern healthcare, giving patients unprecedented access to clinicians and clinicians instantaneous access to patient information. Unfortunately, the state medical boards have enacted a series of burdensome regulations that thwart the use of this technology. The regulations not only compromise patient care, they appear to violate physicians’ rights under both the 1st and 14th Amendments to the United States Constitution. This presentation provides an analysis of the problem and discusses how the medical boards went awry. In part, the presentation is based on a paper Dr. Cotton had published in the Journal of Telemedicine and E-health.
Legal Aspects of Anti-coagulation
Coumadin is the subject of more medical malpractice claims than any other medication. Although the newer oral anticoagulants offer easier dosing and potentially less complications, they have the problem of irreversibility and are plagued by the ongoing threat of class action, products liability litigation. This presentation puts these issues into perspective and provides practical guidance for managing anticoagulation.
Medical-Legal Aspects of an Online Presence
Most medical practices have a website which provides information about the practice, offers various types of patient education, and often allows patients access to their personal medical information. Many physicians are also involved in other online activities, including email, blogs, chat rooms, Facebook and Sermo. These activities raise a number of legal concerns including false advertising, copyright violation, patient privacy, defamation, and medical malpractice. This presentation provides practical guidance on participating in these activities in a legally sound manner.
What should be documented when a patient suffers a bad outcome, perhaps due to a medical error? When treating clinicians disagree? When the patient’s insurance company refuses to pay for necessary care? When the literature is contradictory or non-existent? When the EHR mandates the use of a template that is not entirely applicable? This presentation provides practical guidance on managing these common dilemmas.
Protecting Your Financial Assets
Physicians’ financial assets are subject to numerous threats, including malpractice litigation, Medicare audits, lawsuits from employees and former employees, practice dissolution or bankruptcy, and various events in our personal lives. This presentation provides guidance on weighing the degree of these threats, understanding which assets may be at risk, and taking steps to ensure they are adequately protected.