Malpractice Litigation and ER Documentation: Spotting Claims, Identifying Exposure, Assessing Liability

Mary A. Azzarito | Adler, Cohen, Harvey, Wakeman and Guekguezian, L.L.P

Mary M. Azzarito is a partner at Adler, Cohen, Harvey, Wakeman & Guekguezian, LLP in Boston, with more than 30 years of experience defending physicians, hospitals, and healthcare providers in complex medical malpractice and professional liability cases. She has tried and won high-stakes jury trials involving emergency medicine, obstetrics, cardiology, and pediatrics, and was counsel in the first Massachusetts hearing applying the Daubert/Lanigan standard for expert testimony. Ms. Azzarito’s work emphasizes the critical role of accurate documentation and electronic medical record (EMR) management in emergency-room litigation, and she regularly advises on strategies to strengthen recordkeeping practices, reduce exposure, and defend against allegations of negligence or record deficiencies. Her combination of courtroom experience and regulatory insight, particularly before the Massachusetts Board of Registration in Medicine, makes her a leading authority on the intersection of ER operations, medical records, and malpractice defense.

Kenny Stein | Kenneth A. Stein, MD

Kenneth A. Stein, MD, is board-certified in both Emergency Medicine and Internal Medicine and specialty-certified in Neurocritical Care. Dr. Stein has practiced Emergency Medicine and Critical Care Medicine for 27 years.

As an expert witness for both plaintiff and defense, Dr Stein has reviewed over 700 cases and has testified 300 times in cases related to emergency medicine, critical care, internal medicine, and personal injury. Dr Stein clearly explains completed medical situations, so they are understood by judges and juries.

Michelle Williams | Baker, Donelson, Bearman, Caldwell & Berkowitz

As former in-house counsel at large academic medical centers, Michelle Williams draws on her industry experience to advise on regulatory and structuring aspects of hospital mergers, acquisitions, and integrations. She has a reputation for smoothly obtaining attorney general and federal approvals for complex transactions, and she also advises on EMTALA, QIO hearings, medical staff issues, corporate governance and hospital authorities and districts.

Ms. Williams focuses her practice on the regulatory and structuring aspects of hospital mergers, acquisitions, and integrations. Her experience includes obtaining attorney general and federal approvals for complex transactions and/or conversion from nonprofit to for-profit status, and issues of successor liability. She also advises on corporate governance and Medical Staff governance in connection with changes of control or ownership. She represents clients undergoing CMS, EMTALA and state surveys, Medicare terminations and regulatory review, and advises on hospital authority law, voluntary disclosures, corporate integrity agreements and qui tam defense.

Since 2012, Michelle has been recognized by The Best Lawyers in America® in Health Care Law. Chambers USA has listed Michelle as a leading health care lawyer since 2008.

Prior to joining Baker Donelson, Michelle was a commissioner on the Advisory Committee on Childhood Vaccines, advising the U.S. Secretary of Health & Human Services on the National Vaccine Injury Compensation Fund. She was a former in-house counsel at University Hospitals of Cleveland and the former Mount Sinai Hospital, and has been on-loan in-house counsel to general academic medical centers.

Bahati Mutisya | Baker, Donelson, Bearman, Caldwell & Berkowitz

Bahati Mutisya has experience with Medicaid and Medicare regulations and audits, including defending clients who have received recoupment and termination notices from those programs. She represents providers before managed care organizations and the North Carolina Office of Administrative Hearings on issues related to licensure, pre-payment review, and post-payment review. In addition, Bahati advises psychiatric hospitals on compliance with state and federal rules related to caring for the mentally ill and guardianship and represents hospitals in involuntary commitment hearings in district court. She also provides guidance to providers regarding compliance with various health care laws including HIPAA, 42 CFR Part 2, EMTALA, and the federal False Claims Act.

Bahati is an adjunct professor teaching health care compliance in the Master of Studies in Law program at Wake Forest University School of Law. Her course covers health care compliance topics and laws, progressing from the basics of a compliance program to specific issues facing the health care industry.

Outside of health care, Bahati has counseled private businesses and local governments in regulatory issues and civil litigation. She has significant experience representing clients before governing bodies and elected officials. Bahati has also assisted municipalities with land use regulation, advised real estate developers on compliance with local zoning laws, and defended developers in real property litigation.

Bahati clerked for The Honorable Anna Blackburne-Rigsby, who is currently the Chief Judge of the District of Columbia Court of Appeals. She also served as a law clerk at the U.S. Department of Justice (DOJ), Executive Office for Immigration Review, and as a law clerk at the DOJ, Civil Division, Office of Immigration Litigation. Prior to attending law school, Bahati taught calculus supplemental instruction sessions for freshman calculus students at Carnegie Mellon University in Doha, Qatar.

Session I – Medical Malpractice Defense and Emergency Room Records: What Attorneys Need to Know | 1:00pm – 2:00pm

• Emergency department documentation & litigation risks
  • Chronology of ED visits, physician notes, and records from other providers
  • Issues with communication, EMR use, and pitfalls like text messages or copy-paste practices
• Accuracy, follow-Up, and liability Exposure
  • Importance of documenting medical decision-making, disposition decisions, AMA discharges, and follow-up on lab/radiology results
  • Case examples highlighting exposure risks and incidental findings
• Evidence & trends in EMR practices
  • Audit trails, late entries, and attestations as evidence
  • Embedded warnings, evidence-based recommendations, and how to evaluate ED records for malpractice defense

Break | 2:00pm – 2:10pm

Session II – EMTALA Compliance, CMS Standards, and Hospital Risk Management: The Role of Record-Keeping | 2:10pm – 3:10pm

• EMTALA
  • Core requirements
  • Enforcement & penalties
  • Legal insights
• CMS (CoPs)
  • Regulatory purpose: Minimum safety and quality standards for Medicare/Medicaid participation
  • Key ED-related cops
• Hospital risk management concerns
  • Administrator goals
  • Risk hotspots
• Record-keeping & discovery
  • Electronic Medical Records (EMRs)
  • Discovery strategy
• Practical guidance for physicians and hospitals