OBSTETRIC MALPRACTICE CLAIMS

American Conference Institute’s 13th Annual Advanced Forum on
OBSTETRIC
MALPRACTICE CLAIMS
June 25-26, 2014 | The Union League | Philadelphia, PA
Distinguished Co-Chairs:
Joseph S. Picchi
Partner
Galloway, Lucchese, Everson & Picchi
Norman D. Tucker
Of Counsel
Sommers Schwartz
Sessions include:
• New trends in shoulder dystocia cases and the expulsion defense, and hypothermia treatment for newborns suffering from acute hypoxic encephalopathy
• The use and limitations of placental pathology in untoward pregnancy outcome
• “The new tort reform”: Early recognition of injury, disclosure, investigation, settlement
negotiations and ADR
• The use of Oxytocin, hyperstimulation and oxygen deprivation
• Determining when an injury occurred: Infections, metabolic disorders, labor & delivery, genetic defects and beyond
Learn from and network with:
• Affordable Care Act nuances and the collateral source rule
John S. Moore
CNA
• Electronic records and audit trails, and preparing and presenting your witness for deposition
Richard T. Henderson
Transatlantic Reinsurance
Cheryl M. DeKleine
Coverys
• Proven jury selection and communication methods, and harnessing social media when gearing
up for trial
Featuring unparalleled medical insights from:
David A. Clark, MD
Albany Medical College
John Rodis, MD
St. Francis Hospital
Robert Shavelle, PhD, FAACPDM
Life Expectancy Project
Robert H. Allen, PhD, PE
Johns Hopkins University
Brian S. Kern
Bollinger Insurance Services
Michael G. Ross, MD, MPH
Harbor-UCLA Medical Center
Theonia K. Boyd, M.D.
Boston Children’s Hospital
Harvard University
Molly L. Farrell
MGIS Underwriting Managers, Inc.
Robert H. Debbs, DO, FACOOG, Dist.
University of Pennsylvania
Crystal Strader, AIC, CPHRM
Mount Carmel Health System
NEW THIS YEAR! Obtain insight as to the perspectives from the Bench:
Keith Rospond
MHA Insurance Company
Kenneth Appleby
ProMac Specialty Insurance
Michael D. Anderson
Medical Insurance Exchange of California
Harry F. Farb, M.D.
Obstetrician and Maternal Fetal Medicine
Hon. Lorenzo F. Garcia
U.S. Dist. Ct., D.N.M.
Hon. Sandra Mazer Moss
Philadelphia Ct. C.P.
Hon. Alan C. Torgerson
U.S. Dist. Ct., D.N.M.
Hon. Lisa M. Rau
Philadelphia Ct. C.P.
Hon. Jeanne E. Scott (ret.)
U.S. Dist. Ct., C.D. Ill.
Hon. John M. Younge
Philadelphia Ct. C.P.
Hon. Robert B. Collings
U.S. Dist. Ct., D. Mass.
Register Now • 888-224-2480 • www.AmericanConference.com/ObMal
Earn
CLE
ETHICS
Credits
Now in its 13th installment, ACI’s lauded Obstetric Malpractice Claims is the highest level
event that provides maximum opportunities to learn from and network with leading medical
experts, risk managers and insurance professionals, and helps you keep pace with the hot
jurisdictions, case law, new and emerging claims and parties, and advancements in science.
New twists on obstetric malpractice claims are here and it’s more critical than ever to stay on top of all the current
theories and prepare a sophisticated litigation strategy when defending and managing claims.
ACI’s 13th National Forum on Obstetric Malpractice Claims is the only event where law, science, and medicine
intersect and that provides practitioners with clarity and certainty with respect to the industry’s most pressing issues.
No other event allows for unparalleled learning and networking with the nation’s leading hospitals and insurers, top
outside counsel, and renowned doctors and jurists.
Register today to ensure your place by calling 888-224-2480, faxing your registration form to 877-927-1563 or
registering online at www.AmericanConference.com/ObMal
WHO SHOULD ATTEND
� Lawyers, both plaintiff and defense, who litigate medical malpractice cases attend in order to get a solid grounding
on the latest medical issues upon which cases are based. Our faculty of medical and legal experts from around the nation will provide you with the information and strategies that are essential to achieve the best outcomes for your clients
� Doctors, nurses and hospital risk/quality assurance managers attend in order to benchmark their current practices
and procedures and develop a deeper understanding of the current state of obstetric malpractice litigation
� Insurance professionals attend in order to obtain valuable insights and strategies for assessing professional
negligence claims and to better understand litigation strategies and hospital risk management techniques
Register now: 888-224-2480 • Fax: 877-927-1563 • www.AmericanConference.com/ObMal
Day One: Wednesday, June 25, 2014
9:40 Networking and Refreshment Break
7:15
Registration and Continental Breakfast
9:50
8:00
Co-Chairs’ Opening Remarks
New Trends in Shoulder Dystocia Cases
and the Expulsion Defense
Robert H. Allen, PhD, PE
Associate Research Professor
Biomedical Engineering
Gynecology & Obstetrics
Johns Hopkins University
Joseph S. Picchi
Partner
Galloway, Lucchese, Everson & Picchi
Norman D. Tucker
Of Counsel
Sommers Schwartz
8:05
Michael G. Ross, MD, MPH
Chairman, Dept. of Ob/Gyn
Harbor-UCLA Medical Center
In-House Claims and Risk Management
Professionals Speak Out on Obstetric Malpractice
Financial & Legal Decisions, Evaluation and
Settlement of Cases, Insurance Coverage, and More
Robert H. Debbs, DO, FACOOG, Dist.
Director, Pennsylvania Hospital
Maternal Fetal Medicine Network
University of Pennsylvania
John S. Moore
Director- Specialty Strategic Claims
CNA
James Horwitz
Managing Partner
Koskoff Koskoff & Bieder, PC
Richard T. Henderson
Vice President
Transatlantic Reinsurance
• The Expulsion Defense: the impact on juror’s perception of defense credibility & verdicts
• Daubert and Davis-Frye Motions in shoulder cases • Muhammad v. Fitzpatrick and expulsion forces
• Understanding the key risk factors for shoulder dystocia,
how their managed, and the delivery note
• Medical literature on expulsion forces as a cause of injury
Cheryl M. DeKleine
Director, Claims
Coverys
Robert Shavelle, PhD, FAACPDM
Technical Director
Life Expectancy Project
Brian S. Kern
Area Executive Vice President
Bollinger Insurance Services
12:25 Networking Luncheon for Speakers and Attendees
1:25 New Trends in Hypothermia Treatment for
Newborns Suffering from Acute Hypoxic
Encephalopathy
Norman D. Tucker
Of Counsel
Sommers Schwartz
Molly L. Farrell
Vice President, Operations
MGIS Underwriting Managers, Inc.
• Update on protocols and proving Hypoxic Ischemic
Encephalopathy (HIE)
• Update on the clinical trial results concerning the use of
thermal blankets and caps
• Induced hypothermia in severe bacterial meningitis
• Treatment’s effect on motor function and intellectual utility
• Manifestation of injury
Keith Rospond
Director of Claims
MHA Insurance Company
Kenneth Appleby
Director Healthcare Insurance Services
ProMac Specialty Insurance
Michael D. Anderson
Senior Claims Representative
Medical Insurance Exchange of California
Moderator
Joseph S. Picchi
Partner
Galloway, Lucchese, Everson & Picchi
1:55 “The New Tort Reform”: Early Recognition of
Injury, Disclosure, Investigation, Settlement
Negotiations and ADR
Crystal Strader, AIC, CPHRM
System Director Patient Safety & Risk Management
Mount Carmel Health System
Daryl J. Douglas
Of Counsel
Wagstaff & Cartmell LLP
Register now: 888-224-2480 • Fax: 877-927-1563 • www.AmericanConference.com/ObMal
Jury Selection
• “The New Tort Reform” – the philosophy, economic forces,
results driving the new claims approach, and ACOG’s
position
• Determining whether to settle or defend a claim and the
claims evaluation process
• “Bed side manner” – contacting injured patients and
families, and recommending they contact an attorney
• Meeting with claimants and counsel to establish willingness
to cooperate
• Voluntary exchange of pre-suit discovery and the “new
attitude” required
• When, which cases, why, and how one should pursue pre-suit settlement
2:45 • Applying the lessons learned from jury focus groups to your jury selection process
• Making use of critical insights provided by jury consultants
to obtain a more favorable jury
Using Demonstrative Evidence and Themes
• Conveying your message and effectively explaining complex
theories to jurors
• Using aids to explain data, provide accurate representations,
and debunk opposing theories
• Using a clear and concise presentation which conveys
credibility while staying within legal limits
Narrating a Comprehensive Story
Preparing and Presenting Your Witnesses:
A Focus on Medical Experts and Depositions
• Using themes to explain the details to the jury
• Simplifying the critical issues to the jury
• Demystifying complicated technical issues
• Persuasively detailing what is a reasonable risk
Luke M. Pittoni
Senior Partner
Heidell, Pittoni, Murphy & Bach, LLP
The Reptile Theory: How to Counteract It
Andrew S. Kaufman
Partner
Kaufman Borgeest & Ryan LLP
• Overcoming sympathy for injured plaintiffs
• Overcoming juror bias against doctors
- intolerance of virtually any risk of harm
- the assumption that given advancements in medical
technology, any death or serious injury means that there
must have been some form of obstetric malpractice
- explaining hard evidence in a way that lay people can
internalize
- minimizing juror anxiety about injuries to baby and mother
Joseph S. Picchi
Partner
Galloway, Lucchese, Everson & Picchi
John A. Scully
Partner
Cooper & Scully, P.C.
• Ensuring that the witness is adequately prepared for
deposition
• Anticipating where a deposition is heading
• Key considerations for video depositions
• Pitfalls to avoid
• How minor physical and verbal cues can have a major effect on the impact of a deposition
• Watching videotaped depositions to improve your ability to conduct or participate in a deposition
• Incorporating the lessons learned into future depositions
4:00 Afternoon Break
4:10 Jury Selection and Communication:
Current Voir Dire Strategies and Factoring
in the Reptile Theory
5:00 Electronic Records and Audit Trails: The Benefits
and Dangers of a Paperless System
Joshua R. Cohen
Partner
DeCorato Cohen Sheehan & Federico LLP
Kimberly Longford
Attorney
Pessin Katz Law, P.A.
Joe Pickard
Managing Partner
Sweet Law Firm
• Providing assurance of the integrity of the electronic record
and the associated raw data
• How to train users and the risks involved
• Form v. narrative notes
• The use of electronic medical records in documenting labor
and delivery and how that impacts the defensibility and
expert opinion of the case
• Cloning records and the retroactive manipulation of
electronic records
• Implementing enhanced documentation tools to capture
relevant information in the electronic record
Eric J. Stockman
Principal
Neubert, Pepe & Monteith, P.C
William F. Cunningham
Partner
Cunningham Meyer & Vedrine, P.C.
6:00
Conference Adjourns
Register now: 888-224-2480 • Fax: 877-927-1563 • www.AmericanConference.com/ObMal
Day Two: Thursday, June 26, 2014
10:40
7:30
Continental Breakfast
8:00 View From the Bench: Renowned Federal and
State Judges Will Tell You What Works and
What Doesn’t in Their Courtrooms, Why Parties
Succeed and Don’t Succeed in Med Mal Cases,
Novel Trial and Case Management Strategies,
Examples of Bad Lawyering, and More
John E. Hall, Jr.
Partner
Hall Booth Smith, P.C.
Adam Davis
Attorney
Reminger Co., L.P.A.
The Discoverability of the Plaintiff ’s Presence in Social Media
Hon. Lorenzo F. Garcia
U.S. Dist. Ct., D. N.M.
• How to utilize information posted on social media sites
• The use of injury related posts authored by and about the
plaintiff
• The effect of social media in selecting a jury
• How the Plaintiff ’s bar is using public information online
Hon. Alan C. Torgerson
U.S. Dist. Ct., D.N.M.
Hon. Jeanne E. Scott (ret.)
U.S. Dist. Ct., C.D. Ill.
11:30 Hon. Robert B. Collings
U.S. Dist. Ct., D. Mass.
Hon. Sandra Mazer Moss
Philadelphia Ct. of Common Pleas
Minimizing Exposure to Obstetric Malpractice
Litigation: Implementing Preventive Measures,
Reducing Risk and Managing Adverse Outcomes
John Rodis, MD
Chairman
Department of OB/GYN
St. Francis Hospital
Hon. Lisa M. Rau
Philadelphia Ct. of Common Pleas
• Identifying key drivers of risk
• Enhancing incident management practices
• Utilizing a systematic approach to process improvement
• Developing protocols to enable calm and coordinated team
responses in critical situations and reinforce the use of safe
practices
• Developing a culture of safety
• Initiating timely communication with patients and families
following an adverse incident
• Implementing a joint professional liability program
• Achieving measurable results
Hon. John M. Younge
Philadelphia Ct. of Common Pleas
Moderator:
Adam Davis
Attorney
Reminger Co., L.P.A.
9:40 Morning Break
9:50 Affordable Care Act Issues and the Collateral
Source Rule: The Future of Future Care
Caryn L. Lilling
Principal
Mauro Lilling Naparty LLP
Trial and Jury Strategy: Harnessing the Power
of Social Media to Your Advantage When Gearing
Up For an Obstetric Malpractice Trial
Earn
CLE
ETHICS
Credits
Thomas R. Shimmel
Principal
Kitch, Drutchas, Wagner, Valitutti & Sherbrook, P.C.
• Obamacare and life care planning: compensability and cost
of future care in light of medical reform
• Effective motion practice to reign in the future claimed
damages when certain components are required to be paid
• Damages: the effect of Obamacare on catastrophic damages
• Insurance that doesn’t adjust the premium for preexisting
conditions and the denial of coverage for future special
needs
• The surge of applicants entering an already stressed system
as a result of Obamacare
12:20
Networking Luncheon for Speakers and Attendees
1:20 Determining When an Injury Occurred:
Infections, Metabolic Disorders, Labor &
Delivery and Genetic Defects
David A. Clark, MD
Chair, Dept. of Pediatrics
Albany Medical College
Harry F. Farb, M.D.
Obstetrician and Maternal Fetal Medicine Specialist
• Pediatric Neurology: determining when the injury occurred
• The impact of intrauterine infections and genetic disorders
on the placenta and fetus
• Assessing the role of cytokines in the development of long-term neurological defects
Register now: 888-224-2480 • Fax: 877-927-1563 • www.AmericanConference.com/ObMal
• Ascertaining if cytokines were created by HIE injury or
infection
• Detecting signs or symptoms of infection prior to delivery
• Infection as a causal element of cerebral palsy
• Assessing new and emerging research concerning genetics,
gestational diabetes, cerebral palsy and autism
3:00 4:45 Luke M. Pittoni
Senior Partner
Heidell, Pittoni, Murphy & Bach, LLP
Obstetric malpractice cases are extremely difficult to litigate.
In order to effectively examine and cross-examine the expert
witnesses retained in these cases, you must understand the
technical details and medical jargon that are inherent in this field
of medicine. Moreover, you must master the trial techniques
and strategies that are specific to obstetric malpractice cases.
This concluding session of the conference will provide you with
the tools that you need to obtain the best results for your clients
in these difficult cases.
Topics to be addressed include:
The Use and Limitations of Placental Pathology
in Untoward Pregnancy Outcome
Theonia K. Boyd, MD
Department of Pathology
Boston Children’s Hospital
Associate Professor of Pathology
Harvard Medical School
• Use: Assessing mechanisms of intrauterine stress and their timing
• Limitation: Timing intrauterine stress is not equivalent to injury
• General principles
- Markers of intrauterine stress: meconium and nucleated
red blood cells
- The more extensive the features, the longer/more severe
the stressor
- The extent of these findings can be correlated with their
timing
- Placental pathology commonly seen in untoward pregnancy
- Often non-acute mechanisms
- Often multiple co-existent pathologies
- The more extensive/severe the findings, the greater the risk of untoward outcome
3:50 Afternoon Break
4:00 The Use of Oxytocin, Hyperstimulation and
Oxygen Deprivation
• Investigating the facts concerning liability, causation and
damages: what is relevant?
• Formulating a document and e discovery plan that defends
against overly aggressive requests while ensuring compliance
• Developing cost-effective, compliant, and practical
e-discovery and document retention policies and procedures
• The scope of information that defendant hospitals and
medical professionals must turn over to plaintiffs’ attorneys
• E-discovery as it applies to:
o Communication with patients through email and texting;
databases; medical records
• Ensuring preservation of relevant documents
o How long must information be preserved?
• Risks and sanctions that attorneys face if the e-discovery
process is not handled properly
• Confidentiality and privacy issues that arise with patient
information
• Using metadata to establish relevant dates and times
• Ensuring that litigation is not driven by the cost of
discovery
• Ensuring that your client is prepared for trial
• Trial briefs and motions in limine
• Overcoming the challenges of representing the institutional
client
• Jury selection
• Giving an effective opening statement
• Effective use of exhibits
• Final arguments and closing statement
• Making the case for or against damages
o What types of damages and how much?
o Damages experts
• Settlement considerations – strategies for success
Lisa S. Dagostino
Partner
Kline & Specter
• A review of recent cases where Oxytocin has been used to induce labor
• The connection between hyperstimulation of the uterus
and resulting deprivation of oxygen
• Oxytocin induced hyperstimulation and the decrease in oxygen saturation
• The deprivation of oxygen resulting in HIE and the cases
where this has led to PVL and cerebral palsy
• When to stop the use of oxytocin to avoid brain damage or loss
Litigation and Trial Techniques for Every Stage
of an Obstetric Malpractice Case
6:00
Conference Ends
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American Conference Institute’s 13th
Hear from leading physicians, risk managers,
insurance professionals, judges, as well as top
plaintiffs’ attorneys and defense counsel.
Annual Advanced Forum on
OBSTETRIC
MALPRACTICE CLAIMS
Network with leaders from:
CNA
Transatlantic Reinsurance
Coverys
Life Expectancy Project
Bollinger Insurance Services
MGIS Underwriting Managers, Inc.
MHA Insurance Company
ProMac Specialty Insurance
Medical Insurance Exchange of California
Mount Carmel Health System
June 25-26, 2014 | The Union League | Philadelphia, PA
R E g i s t r at i o n f o r m
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