The Charted Defense

A 2023 JAMA Internal Medicine study looked at more than 108,000 emergency department visits across 104 VA facilities and asked one simple question: does the wording in a triage note change how physicians work up a patient? The answer was unambiguous. When the triage note mentioned congestive heart failure, physicians were one-third less likely to order testing for pulmonary embolism — and took fif...

"The Silent Crisis" — Physician suicide and the litigation-suicide link. Covers the epidemiology, why malpractice litigation is a unique psychological stressor compared to other professional adversities, and the systemic silence around it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/subscribe

This episode covers the jury verdict in our case (nearly $20M in damages), then runs a clinical debrief — examining the readmission decision, the diagnostic gap around bronchoscopy and fungal workup timing, the ARDS threshold window, drug selection (itraconazole vs. liposomal amphotericin B), and system-level fixes. Wraps with legal lessons on documentation and how the appellate ruling changed sum...

A competent, experienced physician sits down for a deposition. He’s under oath. The plaintiff’s attorney points to a chart entry — a staph skin infection two weeks before the patient’s back pain visit — and asks one question: “Would you have ordered an MRI if you had known?” The physician answers, “Yes. Yes, I probably would have.” One sentence. One concession. The defense just lost its strongest...

The wrongful death suit against the hospital. Covers the plaintiff's three expert witnesses (internist, ID specialist, pulmonologist) who argue the diagnosis was preventable, and that delayed bronchoscopy, delayed antifungals, and choosing itraconazole over liposomal amphotericin B caused the patient's death. Also covers the defense's summary judgment motion and the appellate reversal that sent it...

It's a Legal Playbook episode covering why defensible malpractice cases still settle — walks through insurer economics and expected value calculations, consent-to-settle and hammer clauses in malpractice policies, the nuclear verdict shadow driving settlement pressure, and the NPDB reporting implications that follow a physician after settlement. Status shows published already. This is a public epi...

A middle-aged man presents with breathing problems, gets diagnosed with pneumonia and discharged, then returns a week later in worse condition. Over twenty lab tests come back negative as clinicians allegedly delay the diagnosis of the “great pretender.” The episode walks through the diagnostic challenge and the science behind causative organism. This is a public episode. If you'd like to discuss...

The season finale puts you in the courtroom. The plaintiff's hematology expert says warfarin was the gold standard and the switch to rivaroxaban was unjustified. The defense experts say the evidence was unsettled and the decision fell within reasonable medical judgment. Same papers, opposite conclusions. We reconstruct both sides of the expert testimony, examine how courts handle gray-zone medicin...

Warfarin had been the standard for APS for decades. Then DOACs hit the market — convenient, no blood draws, no dietary restrictions. But for patients with Antiphospholipid Syndrome, convenience came at a cost. This episode breaks down the pharmacology of warfarin versus DOACs, explains what the TRAPS trial would eventually prove, walks through the patient's prolonged hospitalization and devastatin...

A young mother develops pulmonary emboli — then a thrombophilia workup reveals a dangerous combination of inherited and acquired clotting disorders, including suspected Antiphospholipid Syndrome. As her care fragments across multiple providers and health systems, the stage is set for a critical anticoagulation decision that will define the rest of her life — and this entire case. This is a public...

A young mother survives bilateral pulmonary emboli, only to be diagnosed with a clotting disorder. When her anticoagulation was allegedly switched, the case alleges that a chain of events was set in motion that led to her death. Her family filed a medical malpractice lawsuit. The case survived summary judgment when the court found that competing expert opinions — on whether the prescribing decisio...

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/subscribe

A practical, physician-focused deep dive into the documentation habits that can either narrow or expand malpractice exposure. Using a concurring appellate opinion as the framework, this episode examines three recurring process-of-care vulnerabilities—stale risk assessments, orders without documented reasoning, and chart gaps that leave care indefensible—and translates them into concrete next-shift...

The Charted Defense Newsletter | Michael Coleman MD A malpractice case involving a young child illustrates how recognition and response failures—rather than the initial prescribing decision—can drive catastrophic outcomes and large verdicts. In 2016, while being treated for Burkitt lymphoma at Children’s Hospital the child was started on allopurinol for tumor lysis syndrome prophylaxis, a routine...

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/subscribe

Charting Your Defense is a physician-focused medical-legal podcast presented in a conversational Q&A format. Each episode features a host guiding a structured discussion with Dr. Michael Coleman, a practicing hospitalist and medical director, exploring how clinical decisions, documentation, and healthcare systems intersect with malpractice law. Through case analysis, legal concepts, and real-world...

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/subscribe

A critically ill patient is admitted with end-stage renal disease, pulmonary fibrosis, and heart failure. His skin is intact on arrival. Over the next three months, his condition spirals through ICU transfers, respiratory failure, a stroke, and sepsis — and a pressure injury develops that progresses from a minor skin tear to a Stage IV ulcer with exposed bone. He dies on Christmas Eve. This is the...

On the Record Season 1: When the Wound Speaks A critically ill patient is admitted with end-stage renal disease, pulmonary fibrosis, and heart failure. His skin is intact on arrival. Over the next three months, his condition spirals through ICU transfers, respiratory failure, a stroke, and sepsis — and a pressure injury develops that progresses from a minor skin tear to a Stage IV ulcer with expos...

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/subscribe

When Infection Hides in the Artery The CT scan said brain tumor. The surgeon opened the skull expecting cancer. But when pathology came back, there were no malignant cells — just bacteria that had been silently destroying an artery from the inside. . This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thecharteddefense.substack.com/...