Penn State medical and legal professions join forces for a day

On the witness stand, medical doctor Emily Sim was the fictional Dr. West -- an emergency room physician who intubated a small child in preparation for emergency surgery. After a series of yes-or-no cross-examination questions from third-year law student Bekah Saidman-Krauss, Sim decided to say what she needed to say. “Yes, I moved the tube. Why wouldn’t I? There’s no reason for me not to move it. She’s four. She was the sickest patient I had that night. Nobody is comfortable with an oxygenation level of 78 percent.”

Designed by professors Stephen Wassner and Gary Gildin, the mock trial, held on Oct. 31 and titled “Treating Medical Errors: A Colloquium,” was designed to connect the legal and medical communities in a unique way. Gildin served as a judge and presided over the “litigation,” which included a direct and cross examination of Dr. West, expert witnesses, and impassioned closing arguments from both sides.

Accused of failing to properly place a child’s breathing tube in an emergency room, the fictional Dr. West was on “trial” for medical negligence. The plaintiff claimed that Dr. West failed to correct the error once it was expressly pointed out, causing the young patient, Susan, to suffer profound brain injury from oxygen deprivation. Part of Dr. West’s defense rested on asserting that yes, the tube was misplaced initially, but that Dr. West corrected its placement and failed to document the adjustment on a busy night in the ER. The defense argued that the patient had additional medical problems that could have caused brain injury -- including the injury that brought Susan to the ER in the first place.

For Sim, this mock trial was particularly engaging. She’s in her fourth and final year of a dual residency program in internal medicine and pediatrics at Penn State Hershey Children’s Hospital. She plans to work in a hospital environment, much like the one inhabited by Dr. West. She thought the trial helped her see the importance of communication. “Communication is so important,” she later said. “Explaining why I did what I did on the stand was just as important as the communication between a parent and doctor.”

Judging the day’s events were eight nursing graduates serving as jurors. It was part of their educational training, explained Bonnie Weaver, a nurse educator at Penn State Milton S. Hershey Medical Center. She wanted nurses to get the unique perspective of sitting in a courtroom. “How many people ever get that type of experience?” she said. The jurors found unanimously that Dr. West was negligent but also found that the negligence was not a substantial cause of Susan’s injuries.

After the trial, Gildin led a discussion focused on the question of truth. “Is trial by jury the best way to remedy alleged medical errors?" he asked. Together the physicians, nurses and law students discussed the strengths and weaknesses of the trial court system and debated the feasibility of alternatives, such as “all-doctor” juries or alternative dispute resolution.

A New Medical-Legal Partnership Tradition

Prior to the mock trial, residents and law students collaborated on the case file, divided into two teams. Residents helped law students understand the case file and the realities of practicing medicine, while law students explained their perspective on the legal system. The teams met in person and through videoconference.

“Physicians in general and pediatric residents in particular have very little knowledge about the medical interface with the legal system, and I wanted to see how we could try to improve that,” said Wassner, a professor of pediatrics who specializes in kidney disease at Penn State Hershey Children’s Hospital. His work includes several initiatives in patient safety and hospital quality improvement. “I thought the best way to try to do it is to immerse us all in an event where we live through a case.”

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Last Updated November 03, 2011