Byline: MEREDITH HOBBS, Staff Reporter
WHEN DR. STANLEY P. Riepe decided to go to law school at age 52, he had no intention of actually practicing law.
Riepe, a physician, had spent more than 25 years practicing gastroenterology when he decided in 2001 to get a law degree. He wanted the credential for his effort to establish a joint center between Emory University’s law and medical schools to educate medical students about the law.
“Physicians need to be less intimidated by the law and more informed,” he told me at his new office at The Weathington Firm, the medical malpractice defense shop that he joined two months ago.
Riepe, now 57, took four years to get his degree from Emory Law School because he was still passing endoscopes part-time and Emory doesn’t offer night classes. “What I learned in law school is what was taught on Tuesday, Thursday and Friday afternoons,” he said half-jokingly. He scheduled his patients around his classes and after a morning at Piedmont Hospital, where he was director of endoscopy, he’d drive across town to Emory for class.
Riepe earned both his undergraduate and medical degrees at Emory and has spent most of his medical career on staff at The Emory Clinic and Emory University Hospital. He is also a professor in the medical school, where he teaches an introductory medicine class to first year students.
He graduated first in his class from Emory University School of Medicine in 1974, but said he was in the middle of the pack in law school. “I made Bs and the rare A-minus in law school,” he said, because he had to fit his law studies around his medical practice, as well as his duties coaching his teenage son’s ice hockey team.
After receiving his law degree in 2005, Riepe continued practicing medicine until the following October, when he took a hiatus to try and get the center established, assisted by a grant from Emory. He said the transition in deans at Emory Law School slowed things down. The center is still in a preliminary phase, according to the law school’s new dean, David Partlett, but is envisioned as a place for education, research and policy at the intersection of law and health sciences.
An ice hockey injury launched his career as a lawyer. Last February, one of his players accidentally knocked him down on the ice, which partially paralyzed his right arm and shoulder. Riepe said he cannot do endoscopies until the nerves heal and he regains full use of his arm. The prognosis is that it could take a couple of years to heal, so he called Paul E. Weathington, whom he knew from his 17 years on the Emory Clinic’s risk management committee, and asked him for a job.
He said that when he told doctor colleagues he was joining a law firm, their immediate reaction was to ask what side he was on. When he told them defense, they relaxed.
To doctors, lawyers mean malpractice lawsuits, Riepe told me, so they tend to fear lawyers and feel intimidated and threatened by the law. He recalled the dread he felt every time he received “one of those yellow envelopes” from a law firm. He pulled out a cream-colored envelope emblazoned with the Weathington firm’s return address to illustrate his point.
“These terrorize physicians,” he said. It’s generally routine correspondence, he said, but doctors always fear that the envelope will contain a request to produce medical records–the first step in discovery in a malpractice suit. “To get through a practicing career without being sued is like successfully walking through a minefield blindfolded.”
Riepe has been sued twice. Both cases were dropped, he said.
He believes that teaching medical students some law will help reduce their feelings of intimidation and distrust, adding that one medical resident who was being sued actually asked him if it was necessary to show up for his deposition.
“To hear freshman medical students talk, you’d think all lawyers do is sue,” he said of the students he teaches.
“There are all kinds of regulations that impact a doctor practicing medicine,” he said. For example, he said that patient consent laws changed the profession radically. The law requires that procedures be explained to patients in lay terms so they understand the risk–as well as the risk if they elect not to have it done. Other patients’ rights laws, such as HIPAA (Health Insurance Portability and Accountability Act of 1996), which governs the privacy of patients’ records, have also increased regulations for doctors.
Riepe said that when he was starting out in the 1970s, medicine was still a patriarchal profession where doctors’ authority rarely was questioned. Patients now are more likely to question their treatment, and Riepe said that’s good. And third parties, which he defined as payors, insurance companies and lawyers, second-guess doctors on how they treat patients–which he thinks is not so good.
Doctors have less autonomy and more liability than in the past, he said, which makes a basic familiarity with the ever-increasing complexities of health law important, especially since a lawyer can’t be in the room with a doctor when decisions are made.
Doctors often face medical ethics questions with legal implications, such as patient consent rules and beginning- and end-of-life issues. They also need a basic knowledge of contract law if they join a medical group. A lot of residents don’t know, he told me, that “if they follow the attending [physician’s] instructions and something goes wrong, in all probability they are going to be liable.”
Helpful virus
Riepe said the lawyers he’s talked to about the joint medical-law center are enthusiastic. “They are incredibly willing to help teach,” he said. But some doctors he’s talked to are not so sure that having lawyers teach medical students is a good idea, likening it to introducing a viral infection into medical training.
“You know, there are some viruses that are helpful to the host,” Riepe said good-naturedly.
“I’ve gained an immense amount of respect for the legal profession by going to law school,” he said, adding that he’s gained an appreciation for the “strong ethical basis” to the profession as well as the legal
safeguards that protect the average person.
He hopes the center will be a way for Emory doctors and lawyers to come together and craft better health policy. He brought up Georgia’s 2005 tort reform law, which regulates medical malpractice suits, and which many doctors supported as a solution to what they see as a malpractice crisis.
“Bad tort reform is better than no tort reform,” he commented, pointing out that part of the controversial Georgia law has already been declared unconstitutional. If doctors and lawyers had worked together, it might have been a better law, he added.
He picked up a copy of the new tort law from his desk and leafed through it to read me a rule stating that hospitals are not liable for the actions of health-care professionals working there if they are not employees–and if the hospital posts a sign to this effect, he said, savoring the absurdity, ” conspicuously and in at least one-inch-high letters.”
“I keep it on my desk. It entertains me,” he said.
He thinks the number of malpractice suits in general has leveled off, but added that he’s not sure that the number of lawsuits or the size of the awards is really the problem. “The actual number of malpractice suits is a very inaccurate predictor of how many incidents of malpractice there are,” he said.
The real issue, he said, is finding better ways to catch mistakes before they result in litigation. “There are probably an awful lot of near-misses that are not disclosed,” he said. He gave me an example: A doctor prescribes the wrong medication and no one finds out.
There are all kinds of systems set up to monitor patient treatment–adverse event reporting, length of hospitalization, frequency of hospital readmission–but “if there is a break in protocol and no adverse event, then how do we know there was a break in protocol?”
The specter of malpractice suits drives mistakes underground, he said. “Most doctors are intimidated by law and think it’s not for their benefit. Their interactions with the law are punitive, which does not enhance the likelihood that they will be honest with disclosures.
“Doctors see medical malpractice suits as a lottery. Some people who bring suits are not injured, and there are a lot of people who do not bring suits who are,” he said.
“And just because a payout occurs does not mean malpractice has occurred,” he added, pointing out that the insurance company, not the doctor, has the final say on whether to settle a case.
There should be a way to track near-misses because that’s where intervention can be most effective, he said. “Most mistakes do not occur in a vacuum and only once. A mistake is not a once-in-a-lifetime event,” he said, explaining that they often indicate system problems. He gave me another example: A doctor does not get biopsy results back from the lab that show carcinoma in situ in a tissue (where a cancer has not yet spread). By the time it is finally spotted, it has grown into invasive carcinoma. Doctors order a lot of lab tests and biopsies and if they don’t have a good tracking system, he said, they might not notice if one did not come back.
I asked Riepe how he’s finding being a first-year associate at 57.
“Onerous,” he said. Then he laughed. “I’m not totally treated like a first year,” he admitted.
I asked him if rainmaking is part of his job. “I hope so,” he replied, adding that he can also add a level of expertise in deposing physicians. “There are some answers that the average attorney might not latch onto,” he said.
He can’t depose witnesses unsupervised or practice as lead counsel until he completes the State Bar of Georgia’s Transition into Law Practice program in December, but he said that in his two months in practice, he’s already looked at about 20 cases. He’s been asked to review cases, prepare questions for depositions and help obtain expert witnesses.
“Being a doctor overcomes the intense suspicion a physician has when an attorney calls them,” he said.
Meredith Hobbs can be reached at mhobbs@alm.com.
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