The demise of Flea, who live-blogged his medical malpractice trial

May 31, 2007

Stunning news. The Boston Globe on Flea, his trial and how his blogging ultimately led from a possible victory to settlement:

As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.

Was Lindeman Flea?

Flea, jurors in the case didn’t know, was the screen name for a blogger who had written often and at length about a trial remarkably similar to the one that was going on in the courtroom that day.

In his blog, Flea had ridiculed the plaintiff’s case and the plaintiff’s lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing.

With the jury looking on in puzzlement, Lindeman admitted that he was, in fact, Flea.

The next morning, on May 15, he agreed to pay what members of Boston’s tight-knit legal community describe as a substantial settlement — case closed.

There is no anonymity on the web. If you blog under a pseudonym, people will find out who you are if they really wanted to. So with that in mind, blog as if the whole world is reading and knowing who you are.

It’s unfortunate for all concerned. For Flea obviously. But also for the medical blogosphere. The strength of blogging is its inherent openness and allowing the curtain to be “pulled back”. Now, every post will be filtered through this question: “Will this ever come up in a malpractice trial against me?”

Flea, we’ll miss you and sorry to see things turn out this way.

Update:
Plaintiff attorney Eric Turkewitz called it correctly and has a roundup of the ordeal:

Finally, this case was a tragedy for two parents, and a nightmare for a doctor. If the parents had lost the trial, it would have added yet another layer of extraordinary emotional trauma. If Flea lost, it would no doubt been emotionally difficult for him. A settlement allows each to move on with their lives without the additional fallout of a jury’s verdict. The parents might feel they had their day in court and that the settlement was based on the merits, while Flea might feel it was based on his own carelessness with his writing and the concerns a jury might not like the way his legal team was trying to manipulate the jury. Neither won and neither lost. And sometimes that is all for the best.

MetaFilter comment:
“But when I look at this case, I wonder what we’ve lost. Expert analysis of issues in the pediatric and medical community. Transparancy into the behind-the-scenes aspects of our legal proceedings. Eloquent and insightful content, now gone because your opinion can be a legal liability.”

N=1:
“Bloggers have no real protections against the invasion of their privacy. The healthcare blogging community is the poorer for the loss of Flea’s insights, passions and wit.”

Update 2 -
The Boston Globe with blogger reaction, including mine:
“‘It’s a little bit sad in a way. The whole purpose of blogging is to be open and pull back the curtain to talk about how it really is,’ he said. ‘So the question is, how realistic is that? I think that’s what physicians and other health professionals are wrestling with right now. It’s part of the growing pains of the medical blogosphere.’”

symtym:
“Arrogance, ignorance, or both? Dr. Lindeman’s most potent defense was his character””a character the Flea so thoroughly impeached””case over and settled. Hosea 8:7. For they sow the wind And they reap the whirlwind.”

Mary Johnson
:
“Anyway, a lot of people will be mulling this one over for a long time to come. The lawyers are already spinning it as a ‘win-win’ (I expect Flea doesn’t feel that way). Doctor-bloggers are bemoaning ‘the loss’ of expert analysis, transparency, insight, passion, wit (it’s a long list . . . for the physician known in the blogosphere as ‘Flea’ is a gifted writer).”

Althouse:
“Here’s a tip. Don’t blog anonymously unless you’re ready to accept all the consequences that would come if everyone suddenly knew it was you. Congratulations to the lawyer who figured out that she should ask that question on cross. You know, I love to support bloggers, but this doctor totally deserved what he got.”

Update 3 -
David Catron:
“Flea’s case wasn’t settled on the merits. It was settled because of a few intemperate posts on his blog. Now, there will be lawyers and paralegals all across the country trolling the web for blog posts by anyone connected with a medical defendant. Will they be doing so in states where tort reform has been enacted? I doubt it.”

#1 Dinosaur:
“Flea — and all of us — have a right to blog anonymously. This also means we should have the right not to be compelled to renounce that anonymity. Anonymous blogging didn’t have anything to do with the medical case at hand. What business did the attorney have bringing it up in court at all? Answer: she didn’t. So I repeat, where the HELL was Flea’s lawyer when that question was asked?”

OnThePharm:
“It saddens me when a case is settled not on the facts of the case, but rather on issues that are only tangentially related to the matter at hand, at best. That said, perhaps Flea was confident in his anonymity, but probably shouldn’t have been.”

Ami Chopine:
“It is you and it will sadly be the general public, who do not understand the nature of Flea’s blogging. He was anonymous. We could not check. But Flea’s articles, sharp as they’d sometimes been, had always consisted of sound science. Moreso, the frustration he often expressed was a mark of his compassion for the children under his care. In the blogging world, he was a model of integrity and compassion.

If you accuse of bloggers who defended him of ‘not having the whole picture’, you must accuse yourself of the same thing.

To the lawyer, Mulvey, who claims to have read his entire blog: where is your integrity? Is it truth or power that you love? Is it compassion or money?”

Update 4 -
Kinohi Nishikawa:
“. . . the prosecution was able to cast doubt on the Lindeman’s character — precisely because ‘Flea’ and ‘the real 3-D doctor’ turned out to be the same person, the same ‘cocky bastard.’ Here Lindeman’s metacommentary doesn’t realize its own ironic condition of possibility: that forcefully stating the difference between Flea and the ‘real’ doctor only serves to underscore their inextricability. (You know the type: ‘Really, I’m not like that — in fact, I did it just to remind myself how different I really am!’) This rhetorical move amounts to Lindeman denying his very real investment in Flea as both a cathartic release and an agent, however modest, of public opinion.”

Eric Turkewitz:
“Saltzman informed me during our conversation yesterday that Flea’s attorneys were unaware of the blog, which means of course, that Flea didn’t tell them and he wasn’t prepped by his attorneys on the subject on how to deal with it if it should come up.”

David Harlow:
“This takes the questions about propriety of physician blogging to a whole new level.”

Update 5 -
Orac:
“My bottom line on this is simple. The case of Flea is not the dire signal about the demise of the medical blogosphere that some have been making it into and that I briefly fell for. Rather, it’s a wake-up call about reality. The First Amendment guarantees us freedom of speech and allows us to speak with anonymity. However, just as it does not insulate us from being offended by other people’s speech, it also does not insulate us from the consequences of what we say publicly.”

Notes of an Anesthesioboist:
“The discovery process can’t stay the same after this – it hasn’t been the norm to request blogs, myspace pages, and such, but attorneys are now clearly going to have to take various types of records into account and adapt to the Internet age.”

#1 Dinosaur:
“Although a doctor’s personality, appearance and demeanor on a witness stand are seen as proxies for behavior with patients, I fail to see how actions (or writings) outside the courtroom or exam room have any relevance to the questions that come up in a malpractice trial. I know that’s how the world *does* work. My question is, should it? I say no.”

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{ 59 comments }

1 RJS May 31, 2007 at 6:55 am

Oops. :(

2 DR. MARY JOHNSON May 31, 2007 at 7:32 am

In most settlements (be they malpractice or not), whoever is doing the paying does not generally admit “guilt”. I’m not suprised this case was settled after Flea’s identity was revealed. If the trial had proceeded from that point, it would have been a circus.

The Boston Globe article says nothing about the specific allegations in the case (which has always been a bit of a mystery as, to my best recollection, Flea did not discuss the medical specifics) . . . just that Flea “failed to diagnose” diabetes in a twelve year old and the child died six weeks later.

Since this cat is out of the bag (and if Flea was denied a “possible victory” on the medical merits simply because he was a prominent blogger), it’s probably important now for the medical blogosphere to examine the facts of the case (if the legal theory is that the facts actually matter).

It’s all public record. There should not be any privacy issues to tap dance around.

3 Xavier Emmanuelle May 31, 2007 at 8:41 am

Oh Flea, I’m sorry.

4 Anonymous May 31, 2007 at 8:50 am

This makes me sick…

5 Anonymous May 31, 2007 at 8:52 am

Flea may be book-smart but I don’t think he’s street-smart.
He failed to consider the worst case scenario in both situations, in caring for the patient and in blogging the trial while it was ongoing.

6 Josh May 31, 2007 at 8:57 am

in light of flea’s misfortune and the sermo-ama partnership, i’ve been wondering what the difference is between what sermo does and medical blogging?

after looking at sermo’s site and seeing that it is filled with discussions of actual cases draped with ambiguity no different than on a medical blog, i was left wondering what the difference is between what they’re doing and what medical bloggers are doing….

am i crazy?

7 scalpel May 31, 2007 at 9:44 am

I wonder if Eric negotiated a portion of the (probable policy limit) settlement for his role in the case.

8 DR. MARY JOHNSON May 31, 2007 at 9:49 am

(Again) Anon 8:52, I’d like to see some facts before I make judgments about what Flea “failed” to do medically.

Josh, I’d say that the answer to your question (re: the “difference”) is a whole lot of nothing.

Except that sermo has the mighty AMA’s blessing and the rest of us (who’ve been doing this for a while and have the battle scars to prove it) are fleas to stomp.

Forgive the pun.

9 Kevin May 31, 2007 at 9:58 am

Josh,
I think the difference is that Sermo’s boards are not open to the public.

K

10 Anonymous May 31, 2007 at 9:59 am

Just curious. ive been getting bits and pieces of this one… Did his blogging Cause his LOSS of the case? or did it help to get a lower settlement? What were the circumstances of the case? All I saw was WRONGFUL DEATH. well thats pretty significant. you cant blog your way out of that i think. and blogging might be conisidered inappropriate in consideration to the patients suffering. im not so sure im impressed by this “flea” at all. but fill us in with a summary KEvin. yes blogs are great. but certainly they can get you in hot water too. its going to happen more and more.
if you think you are going to be totally anonymous think again. people can and will figure out who you are. maybe some of you know me. ;lol

11 Aggie Sarah May 31, 2007 at 10:08 am

I got to this from Over My Med Body, and since he has comments off, I thought I’d post here. I think what happened really really really sucks, but when in history has something you ever said, anon or not, not been able to come back and bite you in the butt? Unless you are VERY vague or change (heavily) info about semi-specifics and location, and perhaps even specialty, you’re really never anonymous. Sorry Flea. We all hope you’re doing ok.

12 Anonymous May 31, 2007 at 11:37 am

Wouldn’t it be great to see lawyers, judges and newsreporters subject to these same pressures that are embattling doctors? How would that work, exactly? Hmmm….

13 Anonymous May 31, 2007 at 11:49 am

Additionally, in regards to HIPPA, a doctor can not respond to a newspaper article about a case unless it has already gone to trial and the patient’s medical information is then considered in ‘the public domain’. I think newspapers and reporters, in light of HIPPA, should refrain from publishing one sided articles on malpractice cases until the case has been settled and the physician can add a response to the article. I realize that in ‘Flea’s’ case the article came out after the settlement, but I have certainly seen many articles in the newspaper and online that have been published at the mere mention of a lawsuit. This practice is unfair and one sided.

14 Lisa May 31, 2007 at 12:37 pm

I miss Flea dearly.

I think we’ve all learned a lesson from tis experience, woefully at his expense. If you are involved in litigation as a doctor, patient or profession don’t involve details in your blog. Strategy notes, pillow-biting thoughts and jury observations just don’t read well in court.

A new, standalone uber-anonymous blog for legal details may well be in order for people who feel the need to vent their legal woes.

I hope that you com home, Flea. We all miss you. I won’t expect to see you, but I’ll keep the light on just the same.

15 > ScutMonkey May 31, 2007 at 12:49 pm

I am new to the medical blogging world and as a medical student, I am forming my own voice here. Soon after I started, I created an “anon” blog with a vague identity so I could feel more open about honestly sharing my views and opinions. This event is making me think closely about this issue and others. I think I will write something about my take on all this and some important questions I have on my own “anon” blog for starters rather than taking up Kevin’s valuable comment space…!

16 Anonymous May 31, 2007 at 1:05 pm

None of this should come as a surprise but the lessons to be learned here is applicable for any case. Do not give counsel representing the adverse party any additional ammunition. During the case, the only people that need convincing of your points/positions are the jury and the judge (not the general public – leave the “reporting” to the reporters). Finally, there is no guarantee of anonymity – especially if you are “reporting” about your own trial.

~Criminallopath~

17 Anonymous May 31, 2007 at 1:18 pm

“Wouldn’t it be great to see lawyers, judges and newsreporters subject to these same pressures that are embattling doctors? How would that work, exactly? Hmmm….”

Just as it would be great to see doctors subject to the same pressures that are embattling other professions.

Everyone has their crosses to bear.

18 Anonymous May 31, 2007 at 1:19 pm

This is not the end of blogging about your legal issues – just don’t blog about them until the trial is over. Turkewitz is probably the only reason it wasn’t worse, since he warned Flea.

19 Anonymous May 31, 2007 at 1:58 pm

Just as it would be great to see doctors subject to the same pressures that are embattling other professions.”

You mean like the inability to pass on increases in costs of business due to no increase from third payers (ie the government)

You mean like everybody in the allied health field and insurance company’s second guessing every move you make.

You mean like the essential GUARANTEE that you will be sued in your career. Probably multiple to many times.

The fact is pal you have no clue what you are talkng about.

20 Deoxy May 31, 2007 at 2:03 pm

“Just as it would be great to see doctors subject to the same pressures that are embattling other professions.”

Plase give me even one example of which pressure that would be – that is, name a pressure that some kind of profession faces that doctors don’t already have (or hav worse).

Let’s see your list. I’d be highly surprised if you managed to come up with one.

21 Anonymous May 31, 2007 at 2:15 pm

It really amazes me sometimes, how ignorant some physicians are about law, economics, computer science, ethics, etc.

They may be well-rounded going in to med school, but many fail to progress whatsoever in any other areas of thought.

Could Flea really expect his identity to remain confidential when he blabbed specifically about his case to millions of people?

Perhaps my expectations are just too high.

22 Anonymous May 31, 2007 at 2:34 pm

Another lesson learned is not to post anything on your clinic’s website that can be used against you in the court of law such as this statement from Dr Lindeman:

“Most Visits to the Pediatrician are Unnecessary”

Not a smart thing thing to say if you miss a diagnosis.

23 RJS May 31, 2007 at 2:43 pm

“Do you guys have any concept of how the rest of the world gets by?”

Completely irrelevant. And even if it were relevant, your argument is flawed.

“Most people” do not go to college for 4 years, and then on to medical school for 4 years, and accrue hundreds of thousands of dollars in debt along the way. Usually loans are deferred through residency, where one works 80-100 hours a week while making what amounts to less than minimum wage.

There might be a fellowship after that, too. So you’re looking at being anywhere from 30-34 years old — as opposed to 22 for the average college grad, white-collar worker — before you start actually making money. (The whole time the clock is ticking on your debt, and compound interest is working against you.) Meanwhile, if you were a smart person — you would have been maxing out your 401K and Roth IRAs the entire time, at a relatively decent rate of return, providing a nice retirement nest egg for yourself with a lot less effort.

You need to think of the cost of education and the OPPORTUNITY COST of not working for at least 8 years. There’s a double whammy there.

If you want to get rich, you DON’T go into medicine.

Doctors pay their dues. Go cry a river somewhere else about how life is hard. The compensation is not commensurate with the amount of hard work required to become a physician — compared to other fields like law and investment banking.

I’m not a doctor, and I don’t intend to become one. I just get tired of all the whiny ninnies with entitlement issues.

24 Anonymous May 31, 2007 at 2:44 pm

Well guys since medicine is my second career guess what I do.

Doctor’s have to make payroll. You think the RN’s and MA’s in the office are volunteer’s? And guess what guy’s whenever, we have an increase in costs, we can’t just pass it on to consumers like most other businesses? Try to make payroll under those circumstances jack. Yeah my salary is higher but I did not start making it until nearly 40 years of age. Add on 200K in debt. The difference between you and me is I have been in another career AND a doctor. I seen both and know both.

PS: The next time you have a 15 yo exsanguinating in front of you we will compare “pressures” OK.

25 one no longer willing to be identifed online May 31, 2007 at 2:51 pm

I am a physician and:

1. I do struggle to make payroll every period,

2. As an internist, I will probably never reach the “average salary of a physician,”

3. Many of the people who pay me are individuals, small business, self-insured, and others, who, historcally, have gone out of business plenty.

It’s amazing to me how many non-physicians reading/posting this physician-oriented blog keep telling the physicians that they have no idea what it’s like in other professions/businesses. How is it that non-physicians have so much more insight (into businesses they are not involved with) then we do?

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