Tricia Pil, M.D., is a pediatrician and a mother, with a terrible story to tell at Kevin, M.D.:

This is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.


It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of Doctor A and Doctor B, who delivered my two young children at this hospital. My husband and I are eagerly anticipating the birth of our third child.
One evening after dinner, the contractions start coming every five minutes. My husband and I pack our bags and drive to the hospital. I am nearly 4 cm dilated. After observation, Doctor C calls Doctor A, makes a diagnosis of false labor and sends us home.

9:25 pm: 33 year old gravida 3, para 2, 38 5/7 week seen in office this AM almost 3 cm. Negative PMHx, c/o contractions q 5 min. Cervix 3+. Will ambulate 2 hours.
12:15 am: Continued contractions q 5 min. Spoke with Doctor A–home or stay–patient chooses to go home. Keep appointment Monday for induction.–Doctor C

Your presentation to Triage was discussed with Doctor A by the OB Triage Specialist. Since there was no change in cervical dilation, you were discharged.

You can tell where the story is going.

The facts of her case are depressingly familiar to me. The diligent mother-to-be presenting at Labor and Delivery with the very symptoms her obstetrician and every book, magazine, and website about pregnancy says are a sign of labor. The dismissal of her concerns, the allegation that she is neurotic and overreacting, the matter-of-fact discharge without consulting her, and the falsification of medical records.

The mother-to-be’s return, followed by eye-rolling, sighing, and the whispered complaint that she’s back again. She’s not in labor. She’s crazy. She’s annoying. The denial that she’s in labor until the very delivery itself. The ludicrous demand: don’t push. Wait for us. Resist millions of years of mammalian evolution.

Postpartum, the rough handling, the belittling of her conditions and concerns, more falsification symptoms in the medical record. Snide remarks. More allegations that she — not her condition and certainly not the doctors of the nurses — is to blame for everything.

Weeks and months later, the failure to take any responsibility at all, even after the fact, and to treat her like an idiot for believing she deserved better.

I’ve seen it all before. See it all the time. Our case intake files are filled with client narratives describing crude, heartless and substandard treatment that differs markedly from medical records but always say the patient chose to be discharged from the hospital, sometimes against medical device.

Alas, there’s nothing I can do for most of them. I would not have put it the same way that a plaintiff’s lawyer told her:

He listened sympathetically and then zeroed in on the key word–damages. Aside from my psychotherapy bills, it was hard to pinpoint a lasting physical injury to me or to my baby. “This case would be worth a lot more if we had three motherless children or a brain-dead baby in a wheelchair,” he said. That’s when I politely thanked him for his time.

I wanted an apology, answers and change–not money.

But the lawyer wasn’t wrong. Obstetrical malpractice cases are difficult and expensive. They take years and hundreds, sometimes thousands, of hours, as well as hundreds of thousands of dollars spent out of pocket to pay for experts and other litigation costs.

Putting aside attorney time, her case would easily cost $250,000 just to survive summary judgment. You’ll need an obstetrician to comment on the discharge and the delivery, a pathologist to look at the report on the placenta,  an emergency physician and/or hospitalist to comment on how the hospital handled her hemorrhaging, and a neonatologist to comment on how the hospital handled the baby’s discharge and re-admission. If the defense coughs up some irrelevant expert — perhaps a psychologist, to say the mother had pre-existing undiagnosed depression, or issues with her father, or some other nonsense — you may need to get one of the same to rebut them.

Your paralegal will spend thousands of hours just sorting through the records to give you their thoughts and to get the records to the experts in a presentable and organized form, since the experts bill by the hour. If you are lucky and efficient, you can file all the necessary pleadings and motions, and conduct all the discovery and depositions, in less than 100 hours of work. That’s a generous estimate; you will likely need many times that.

In discovery and at trial, the doctors will have explanations for everything, as will the defense lawyers. Your client is just in it for the money. Are you accusing these good doctors of falsifying medical records? That’s outrageous. She’s a liar. Why would the nurses and doctors falsify a medical record? They were trying to help her. It’s her fault.

And on and on and on. For what? You don’t have, as the tort reformers say, “economic damages.” You “only” have so-called “pain and suffering,” which more than a generation of insurance industry and health care industry propaganda has taught jurors to mean nothing.

It’s hard for me to accept she “wants an apology, not money,” because there’s no money to be had. The insurance and health care giants have made sure of that. I didn’t see Dr. Pil volunteer to deposit a retainer of $500,000 to cover the pre-trial costs and attorney’s fee to have her rights vindicated. That’s what it would take.

Birth injury cases are risky enough when the child has been injured and needs millions of dollars worth of care for the rest or his or her life. If there are no economic damages, then there is no question: you cannot take the case. If you do, it will swallow up your time and bankrupt you.

The hospital knows it. The insurance company knows it. That’s why it’s so insulting that they can’t even apologize to her, a pediatrician, “one of their own,” for treating her with less respect, and less concerned for her safety, than a veterinarian would have treated her pets.

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