“This is someone else’s daughter who could die.”

Those were the first thoughts that went through Elizabeth Strubel’s mind when she learned of the unexpected outcome.

The worst part?

The way she found out.

“I suddenly had long-time high-school friends calling to see if I was OK,” she recalls. “They had read it on the front page of our hometown newspaper before I even knew about it myself.” The local paper hadn’t attempted any contact for comment, or even to verify the story’s facts. They’d just run with the story, on the heels of a more devastating missed meningitis case, thinking they had an ongoing public-health issue to cover—which amounted to a dramatic upheaval for Elizabeth Strubel, PA-C, and her family.

“At first, I went over it in my mind so many times and thought, ‘I don’t see any obvious mistakes. What did I miss, what’s wrong with me?”

- Elizabth Strubel, PA-C 

The family impact
“Because it was so public, it involved my entire family—everyone was impacted by the press,” Elizabeth remembers. “We had a family meeting with my parents, siblings, aunts, and uncles to discuss how we could proceed. I wanted their input, since the public nature of the story had an impact upon them too. My husband’s clients were even remarking to him about what they had read. My mother’s colleagues commented. Everyone in the family had to answer to it at some point.”

In addition, the news broke one week before Elizabeth’s delivery of a closely-monitored, high-risk pregnancy. Her road to motherhood had already been stressful, as she had previously endured miscarriages, plus the devastating stillborn delivery of her first child. The stress of the widely publicized claim made this next high-risk pregnancy even riskier.

The personal doubt
“At first, I went over it in my mind so many times and thought, ‘I don’t see any obvious mistakes. What did I miss, what’s wrong with me?’” Elizabeth says.

Elizabeth, a physician assistant since 2008, notes that in a situation like the one she was in, it’s easy to start doubting everything you do. You question whether you’re in the right profession. You wonder if every sore throat you see is really something more serious, something deadly. Are you missing something important or dangerous? “You will just want to quit, give it all up, and become  a coffee barista,” she says, “until you realize how much you really are helping most patients.”

“Now I just make sure every chart I close can stand up in court,” she says. “I make sure I’ve included the details of my thinking. At first, I might have been a bit less efficient, but now I’ve found the right balance. And I sleep well at night, knowing I’ve done the best job I can with each patient—and it’s reflected in the chart.”

Doubt from colleagues—real or imagined
Perhaps working as an advanced practice provider (APP) puts one under even more pressure. As if her own self-doubt wasn’t powerful enough, Elizabeth felt the doubt of some physicians too, who were already skeptical of APPs at the clinic. “There are physicians among us who don’t think we should be seeing patients,” she says. “My case probably didn’t help that opinion.”

However, the doctors who reached out to her with support during this time made all the difference. While you can’t discuss the details of a case, it makes a difference to have people in your corner when you doubt yourself and feel that others are doubting you—whether their doubt is real or imagined.

As for those you think will question your performance? She says that you just have to know there will be some people who don’t have all the facts—and they might not be in your corner even if they did, so don’t focus on them. Focus on those who show you support.

The surprising part
“It was surprising to me how personal it was,” Elizabeth recalls. “I’m such a perfectionist—we all are, or we wouldn’t be doing this work. But even if you do everything right, a claim can surface.”

Also surprising to her was the fact that no one could talk about it with her, and how alone it made her feel. “At every turn, I heard, ‘I can’t discuss the details with you,’” she recalls. “Most work phone lines are recorded, and people can’t tell you ‘Oh, it’ll all blow over,’ because no one knows for sure how things will play out.”
Elizabeth’s advice for others:

Be as honest as possible with your defense team. “Your attorney can’t help you if he or she is blindsided by something,” Elizabeth says. “I told my attorney everything— absolutely everything I was thinking, remembering, and feeling. I was terrified, and all this was happening at such a vulnerable time for me anyway. I think most people try to act strong and tough, but I think knowing how scared I was helped my attorney realize what was needed to prepare me.” Her attorney drove hours to meet with her personally, always  picked up her calls, and, if she had questions he didn’t yet have answers to, always got back to her. 

By the time she testified at her deposition, Elizabeth had gained the confidence to present her story without doubt and fear. “My attorney told me he didn’t think he’d ever seen anyone depose as well," she says. "I credit all he did to prepare me for that pivotal day.”

Find the people and sources who support you. While some providers experience a claim and try to keep their families out of it, Elizabeth didn’t have that option. But the silver lining behind all the press coverage of her case was that she was able—she might say forced—to tap into the tremendous unconditional support that family and close friends will offer.

“My husband was hugely reassuring,” she recalls. “He told me, ‘We’ve been through worse together; we’ll get through this.’” In addition, her extended family shared the attitude that, “Whatever it takes, we’re behind you.”

She also recommends relying on whatever spiritual foundations are grounding and provide solace. Taking the news so personally, she also describes feeling a deep ache inside her for the patient and the patient’s family. “We did a lot of praying—for the patient, and for all of us who were affected,” she recalls.

Talk to those who have been through it before. Fortunately, during her case Elizabeth was able to access the PI Peer Support Program. “It was critical to have someone who had been through the process to bounce things off of,” she says. “I had a couple of Peer Support phone calls with someone who was assigned to me by Physicians Insurance; this gave me a sounding board and guided me to talk to my attorney about certain things.” 

Elizabeth also had a more senior physician pull her aside and talk to her about his own experience. “He gave me great advice about how to handle the case with my kids,” she recalls. “His own kids were around the same age as mine when he went through a claim. He told me that after it was over, he was surprised to find out how relieved they were that he wasn’t going to jail! Kids have no grasp of the situation.” Knowing that, she and her husband were careful to filter their discussions around the kids and reduce how much of the stress came into their home.

Trust the process
At times it might seem like it takes an extremely long time to resolve things or move them along. Says Elizabeth, “There is a process that takes place, and it is for your benefit. It doesn’t happen like on Law & Order.” In fact, even for a pretty straightforward case like hers—which was dismissed during the deposition stage—the whole process still took 18 months. 

Furthermore, while Elizabeth remembers just wanting it all to be over as quickly as possible, the time elapsed during her case allowed for the plaintiff’s side to reveal and document—via the press and social media—critical inconsistencies in their story. And though allowing the plaintiff depositions to happen first took longer, it gave Elizabeth valuable time to learn about the process and become more comfortable with the proceedings.

Trust your team. Elizabeth didn’t always know why her legal counsel wanted her to do things, but she saw in the end that they knew what they were doing and asking of her. “I was just a small square of the quilt, so I didn’t immediately see the overall design that was coming together,” she remembers. She says she eventually came to think of her attorney as the coach, and herself as the quarterback: “He told me what I needed to do in the game and, even if I wasn’t sure at times, I had to do what the coach was telling me.” 

Her legal counsel had her attend every deposition. While it was time-consuming and stressful, it also allowed her to learn more about the process, gain comfort with the proceedings, and take notes. When she was deposed, she was prepared and confident.

“My team had me prepped right down to the blue suit I bought for the deposition,” she recalls proudly. “When we walked into the conference room for the deposition, we all looked sharp, we sounded sharp—we were there to prove the appropriateness of my patient care, and it showed. It all paid off.” 

Elizabeth’s claim representative, Vereleta Steward, says, “I have never seen such a dramatic transformation in someone we have represented. During the 18 months leading up to the deposition, she went from being utterly broken and emotional over the claim, to being a confident and professional witness in her own defense.”

“Personally, I will be forever grateful for the physicians and colleagues who stood by me from start to finish during my claim; they really made a difference in my life.”

-Elizabeth Strubel, PA-C

As for when one of your colleagues is going through it?
Keep checking in. Elizabeth says that some of her colleagues or friends checked in on her in the beginning, but eventually, their check-ins became infrequent. 

“You have to get up, go to work, and do a good job—all with this going on in the background, for months and months,” she says. “It’s just this huge battle in your mind.” She says she could have used far more day-to-day support from people around her—including just having the situation acknowledged. “While someone being sued can’t discuss the details of their case, they will certainly appreciate knowing that you’re thinking of them and what they might be going through,” she emphasizes. “Personally, I will be forever grateful for the physicians and colleagues who stood by me from start to finish during my claim; they really made a difference in my life.”

For Elizabeth, as for others before her, the experience of a claim is certainly one she would have preferred to do without. But as her husband predicted, there are worse things one might have to go through, and in the end, she got through it just fine—with great success, in fact. Immediately after Elizabeth’s confident deposition, the plaintiff attorney approached the defense team, sharing that his recommendation to his client would be to dismiss the claim.