Viknesh Kasthuri and Alexander Homer are the creators of the award-winning documentary, “A World of Hurt: How Medical Malpractice Fails Everyone.”
The film examines the devastating impact that medical malpractice has on patients, doctors and society. Kasthuri and Homer present three stories from the perspectives of patients and doctors who have been directly affected by medical malpractice
In this episode of “Generation Rising,” host Anaridis Rodriguez sits down with Homer, a third-year medical student at Brown University; Dr. Gita Pensa, an emergency physician and expert in medical malpractice; and Dr. Mark Brady, an emergency physician and producer of the documentary.
The documentary is available to stream now on watch.ripbs.org,
The full interview can be found here.
Medical malpractice has a long and complicated history in the United States. It became an even more thorny issue because of the COVID-19 pandemic, which caused a shortage of doctors and nurses.
The documentary, “A World of Hurt: “How Medical Malpractice Fails Everyone,” was created and directed by Viknesh Kasthuri and Alexander Homer a pair of medical students at Brown University.
Dr. Gita Pensa, who in addition to her medical duties hosts a podcast, “Doctors and Litigation: The L Word,” had Kasthuri and Homer as podcasting students in an elective course she was teaching at the university’s medical school. They were asking her about video and whether she could give them some pointers.
“The truth was, no, I could not, but I knew someone who could,” she said, laughing. “And meanwhile, Dr. (Mark) Brady had approached me about — I have been doing podcasting and other work about medical malpractice litigation — and he had had the idea about potentially doing a documentary about that.
“And so, I knew he was looking for people to work with him, and so, I tried to connect them.”
The documentary highlighted a father and a husband, along with a sister
and a child. Some of the cases went to trial while others did not.
Putting stories together was a long process
Homer said that Pensa connected him and his co-director with people to interview.
“And from then on, it was just years of Zoom meetings, phone calls, cold emails,” he said. “And, you know, unsurprisingly, not a lot of people are willing to talk about this, especially in front of a camera.
“And so, that’s the reason why it took so long to put these stories together.”
Homer praised those people in the documentary who did go on camera and “share those really deep moments.”
Brady said there were legal implications because some of the cases contained nondisclosure agreements, preventing people from speaking publicly about it — that was why “it took so long to find people,” he said.
“We couldn’t find anybody in the state, or anywhere around here that could, or would be willing to go on camera, which is why we had to go to Washington State, North Carolina, and Michigan to get some more people who were willing to go on camera, and who are able to go on camera,” Brady added. “When a case is resolved, usually the parties, they sign a nondisclosure agreement, so you’re gonna agree that you’re not gonna ever talk about this again, and there’s an undisclosed settlement usually, and that’s the way that cases usually end up.
“So finding plaintiffs who are willing and able to go on camera was very tricky, and finding lawyers who are willing to go on camera as well, ‘cause they’re not gonna go on camera, and say something that’s gonna make them, or their clients look bad.”
“So it took probably a few dozen Zoom meetings over the course of probably three years to get our subjects.”
Brady said two things about each story were compelling.
“One, they’re valuable, ‘cause they’re hard to find. People, you know, you’re not gonna walk up to somebody and have this conversation,” he said. “But it’s a conversation that everybody has behind closed doors. And so, it’s something that’s kind of, in the medicine world, it’s taboo.
“And two, (we) wanted to find stories that people, there was something about the relationship that was broken, and then you can highlight the problems with the system, because you can highlight what’s broken with the relationship, and between a physician and a patient, you’ve got a lot of trust kind of going both ways, and when the legal system gets involved, that trust is broken, and both parties usually end up the worse for it, and usually not, nothing’s really better at the end of it.”
A 12-year legal battle
Pensa was one of the main subjects in the film because of her personal experiences relating to medical malpractice. She was the only physician defendant in a $28 million demand case involving a 31-year-old woman that spanned 12 years and two long jury trials.
“When I was named in the lawsuit a few months later, I just was completely flattened,” Pensa said in a 2023 interview.
Pensa went to trial in 2011 and won the case, but the verdict was overturned in 2015. A second trial began in 2018 and Pensa prevailed again.
“But the whole experience to me was utterly life-changing,” Pensa told “Generation Rising.” “I hadn’t had any instruction in how to think about it, how to deal with it.
“The first thing that happens is you show up in an attorney’s office, and they tell you not to talk about it, but it was really, really a hard thing to carry, and I judged myself a lot for not being able to deal with it because I feel like that’s what doctors do.”
During the later stages of the trial, Pensa said she realized that she should be approaching how to handle “some pretty tough stuff” differently.
“We should be teaching about it, we should be talking about it,” she said. “And so, I’ve made that more of a mission of mine now.”
After joining the faculty at Brown, Pensa said she found a niche — educational technology.
“And so, that’s where I learned how to podcast and things like that, and actually wound up deciding to make a podcast about medical malpractice litigation,” she said. “And then from there, it became, you know, in a niche way, really popular among physicians, and so, I was asked to speak and teach more.
“And so, now I actually do quite a bit of that, and I coach defendants who are in need of well-being support and things like that.”
Trying to keep the therapeutic relationship alive
Brady said that a malpractice lawsuit “pits the doctor against the patient.”
“That really destroys the therapeutic relationship, that, you know, kind of makes the patients not trust the system, and you’re no longer gonna be getting care from that doctor,” he said. “Kind of it breaks down the relationship, and that’s the core of what I think the issue is, and where we can improve things by keeping the therapeutic relationship alive, and making the system not so adversarial, so that you can still be treating these patients as patients and showing that you still care about them, even when bad things happen, and the system really isn’t set up for that right now.”
Homer said that when he and Kasthuri were undergraduates at Brown, they co-hosted a podcast that explored the patient-physician relationship in a positive light.
“That was really the jumping off point for this documentary,” he said.
One focus of the film was mental health, and it delved into the number of providers who have committed suicide. It is one of the issues that had never been openly talked about before, Pensa said.
“My own personal experience led me to understand what a trauma it is for the physician, or the provider rendering care to be in this system, and at the same time, it is obviously the plaintiff, or the plaintiff’s family has suffered some sort of trauma, and all of the humanity gets taken out of it,” she said. “You don’t have any opportunity to come together, to heal, to talk about what happened.
“But I know from my own experience and then from working with people that malpractice litigation is for the providers a real driver of depression, anxiety, burnout, substance use, divorce, and unfortunately suicide, and physicians have twice the rate of suicide of the general population, and now we have the data to show that civil litigation is a driver of suicide, among a number of other issues.”
Keeping trust between a patient and physician is a key element in their interaction. Legal issues put that trust at risk.
“When you go to a doctor, you hope that there’s gonna be an open dialogue, and that there’s gonna be a level of trust between you and your physician,” Homer said. “But then unfortunately, when medical malpractice comes into play, and sometimes when there’s an adverse event, then those wagons circle, and patients can’t get answers.
“And, you know, doctors who really wanna help their patient, who wanna communicate, who wanna teach, and who wanna be there for their patients aren’t able to do that.”
When there is an “adverse event,” lawyers come into play and that is generally how the patient and physician/hospital communicate.
“That’s usually how things work, and that’s where really the patients get stuck in the middle, and the doctors too, and it’s adversarial,” Brady said. “Nobody feels good at the end of it.
“Nobody feels like anything changed at the end of it. That’s usually how things play out,” he added. “There are exceptions, and there’s a whole spectrum of different programs that have been tried, but it requires a lot of input to set up those other programs, and everybody is caught in this situation where on the health care side, we all wanna be better, we wanna do what’s right for the patient, but we have a very adversarial, you know, legal system that the health care system really doesn’t, we don’t have any say into it.”
“So the change has to happen on a ... political level to change the rules if you wanna make things different.”
Homer said a person viewing the documentary may not realize that it was the first time they had met with the filmmakers.
“And so, we’ve communicated over email, they have a general idea of what our mission is, but that’s the first time where we’ve met them, walked into their living room, sat down across from them, rearranged their furniture, right?” Homer said. “Their kids are sort of poking their eyes through in the background, and they’re opening their heart up to us, and I think that, you know, a lot of credit should be given to them for doing that, right?
“To have these strangers sitting across from them, and to open up their hearts, and tell us about probably one of the most, you know, emotional moments in their lives, the passing of their child, and I think I was just floored by they’re willing to do that.”
“And really our job as, you know, documentary filmmakers is to do right by them, right?”
