#128 - When your Clinical Documentation Ends up In Court: What Healthcare Providers Need to Know with Dr. Pankti Fadia, Part 1

Welcome to The Factor Podcast, where we talk about the stuff they didn't teach you in school, how to grow your practice, refine your clinical skills, and get better results for your patients. We're here to help you navigate the real-world challenges of being a healthcare provider, from delivering top-notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective cutting-edge treatments to get patients better faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field so you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts, industry innovators, and respected clinicians across a wide range of specialties, you are in the right place, my friend. Let's dive in. Welcome back to The Factor Podcast, where we bridge the gap between rehabilitation, performance, and real-world clinical practice. I'm your host, Jessica Riddle, and today we're kicking off a powerful 2-part conversation on a topic that many providers know is important, but let's be honest, most would rather not think about until they absolutely have to. We're talking about what happens when your clinical documentation, your treatment decisions, and your professional credibility enter the legal arena. Our guest today is Dr. Pengti Fadieh.

Hi, Jessica.

A practicing chiropractor with more than 8 years of clinical experience in personal injury care. She served as a clinical director and has practiced across Houston, San Antonio, Beaumont, and Las Vegas. In addition to her clinical work, Dr. Fadiah is also graduating soon from law school, actually within the month, with a focused interest in the intersection of healthcare and law. Her work is dedicated to helping chiropractors better understand medico-legal standards, Strengthen their documentation, improve clinical credibility, and navigate the legal aspects of patient care with more confidence. In this first part of our training, Dr. Fadila will walk us through the personal injury case timeline. We'll talk about the difference between clinical causation and legal causation, why your documentation matters long before a case ever reaches a courtroom, and some of the most common charting mistakes that can weaken your credibility. Whether you treat personal injury cases every day or only occasionally encounter them in practice, this episode is a strong reminder that your notes are not just clinical records; in certain cases, they may become evidence. So, if you've ever wondered how your documentation might hold up in a deposition, want to know a little more about what attorneys are really looking for, or know how to better protect both your patient and your professional credibility, this is an episode you'll want to listen to closely. Let's cue the intro music and get started.

Thank you. Thank you, Jessica, for giving me this opportunity. This is my first time doing a live webinar, so Welcome everyone. My name is Dr. Pengti Fadiah. I am a practicing chiropractor. I do this full-time Monday through Friday for past 8 years, and I love my job. And about 3 years ago, I decided to go to law school because I want to transition to legal career, basically doing everything that I'm doing right now, but from the legal side. And so while we're going live right now, we're recording this. I am pending my bar examination this July. So if everything goes well, I will be a JD in, in a few months. And so it's an interesting journey. And when I started my legal career as a student first, I realized that there's this need for chiropractors to understand what happens when you're practicing chiropractic with respect to personal injury. So today's topic is From Clinics to Courtrooms, and the goal is to give you an overview of what personal injury litigation is. A lot of us are thrown into practice once you graduate, you're just from chiropractic school and you're applying to jobs. The reality of our profession is that the high-paying jobs are personal injury jobs. And so not a lot of us have the opportunity to pick what we want to do. Most of the times students will just take whatever job they can get. And as an associate chiropractor, you don't know what your practice is going to be. It could be 50% health insurance cash, it could be 50% PI, or it could be more than that. You just don't really know. And a lot of associates are switching jobs in the initial years trying to understand what they really like. And in, in that initial years, you are going to come across a personal injury case, whether you own your own practice or you're working for somebody else, an associate. This will happen. And it happened to me. And oftentimes what happens is once you switch jobs, you're done with that clinic. And a couple years later, you get subpoenaed to appear for a case that a patient that you've seen for this particular clinic 2 years ago. You have no knowledge of what to do and how to proceed from here. So this lecture is an overview of what happens. So what can you do to be more prepared, whether that's giving depositions or testimony in court, or just the whole idea of what personal injury practice is from the legal perspective. So if you do this for a living, if 99% of your practice is personal injury, you will really find this lecture very helpful. And even if you don't do PI, at some point in your chiropractic career, you will come across attorneys. You will come across patients that never wanted to sue an at-fault driver, came to you because they were hurting, later on changed their mind, and now you're stuck with the process anyway. So thank you so much for giving me your time. I know your time is valuable, and in the next 50 minutes I'll try to touch on some important issues. And then depending on your questions and if there is demand, we can go into more details into giving depositions and things like that down the road. So yeah, just a little bit about me. Like I told you, been practicing for 8, 9 years now and about to graduate law school. I have published 2 articles, which is really rare in our industry. So shout out to Parker University. My first article is for chiropractors. It's— that's where this topic came from, and it is published in the Journal of Contemporary Chiropractic. That's the link if you guys want to check it out. Another way to find this is if you type my name in Google, the link pops up. And the second article, which is Chiropractic Evidence in an 18-Wheeler Collision Litigation: From Treatment to Testimony, this one is in the Law Review Journal. Which is a big thing if you are working in the legal side. So for lawyers, that is a legal journal. It's prestigious. And this article was designed towards communicating to the legal community, the lawyers, educating them what chiropractic is, how they can use chiropractic evidence in legal cases, how they can build our credibility. Things like that. Because as you're aware, you're a practicing chiropractor, that we're not only competing amongst ourselves to get business, we're also competing with the physical therapist community or medical doctors. And so a lot of the times outside our profession, attorneys are not aware of the things that we can bring on the table. So that was my goal, to then communicate to the legal world and say, hey, I'm a chiropractor and I'm also going to be one of y'all. So I wrote this article and it's an honor to be able to communicate to doctors and also attorneys and bridge this gap. So why this matters? Like I said, your notes will end up in court. It doesn't matter whether you're practicing 100% PI or you're just taking random 10, 20% of your cases in your practice, or you're working for somebody else. Sooner or later, you will come across personal injury, and so your notes will end up in court. And so we have to make sure that the minute we get a new patient intake, to you're giving a testimony to the— in the courtroom, like you're prepared. Knowledge is power. And confidence is the key. And how do you get that confidence if you know what you're doing? It builds confidence. Attorneys will depend on your documentation. And when I say attorneys, I mean plaintiff attorneys. So this is— we don't use the word plaintiff and defense in practice. We just call them attorneys. But there are 2 types of attorneys. Of course, for every case, both sides are arguing using your notes. Plaintiff is patient. So patient's attorneys are plaintiff attorneys. They are the ones that are suing the at-fault driver and their insurance company. And then there's defense attorneys. Defense attorneys are defending the insurance companies. And for us, defense attorneys are not our friends. They are the ones who are trying to use our notes and find everything that they can to make us sound like we're not credible, that we don't know what we're doing. that we're being dishonest and we are LOP-driven, meaning that this whole scheme is made up and it's, it's their job. So never take a defense attorney personally. Just, just understand that that's what they're doing. That's their job. And then there are plaintiff attorneys. Now, you would think that plaintiff attorneys are your friends. Well, they're better than the defense attorneys for sure, but they're also not your friends. Because their duty is towards the client, towards your patient, not towards you. But in day-to-day practice, what— when we say we work with attorneys, we work with plaintiff attorneys. These are the billboard attorneys that you see. These are the attorneys that will send you what's called an LOP, which is letter of protection. So weak records equals poor credibility in the legal world. When somebody's speaking as a witness, a jury or a judge is deciding whether or not that person is truthful, and it all goes down to credibility. For us chiropractors, the way we prove that we're credible is through our notes. So like I said, from intake paperwork when you see the patient for the very first time to your last visit, That is where your entire universe of credibility exists. If it was not documented, it never happened. If you document things that you should not be documenting, it is going to get highlighted and twisted and presented to the jury and the judge trying to attack that credibility. And I will show you some things that you can do to increase The power of your documentation to sound more credible, depending on the facts of the case. And every chiropractor has his own style, the own way of treating things like that. So you have to understand that you you can't be me and I can't be you. But some of the things that we do as professionals in our education will give us a lot more power as compared to our counterparts. Even medical doctors or PTs, things like that. And last but not the least, the lecture will also talk about how chiropractors can get in real trouble. And I'm not talking about this PI case, but in general outside, whether that's your license or getting in trouble with auto insurance companies. So the last segment of this lecture will focus on ethics. So let's talk about the PI case timeline. Most of the time somebody will get into an accident, will hire an attorney, and if you work with them, that lawyer will send you an LOP and you're asked to schedule a patient. The patient will start treatment. This is pre-litigation phase, meaning there's no ongoing case against any insurance company. This is where a lot of evidence is being gathered. That's where you come in. So all the patients that you're seeing while they're alive with you, The case is going to get into litigation. That's why your notes matter. But right now there's no pending case, and that's all pre-litigation. You'll hear that word a lot in practice— pre-lit, pre-lit, pre-litigation. Litigation meaning once you file paperwork in the court, at this point the case is being litigated, meaning that it's actively being worked at in the court proceedings. So the treatment happens at your office. You may refer them out to other providers. They will go do whatever they need to do, and at some point the treatment will be done. This is when attorneys will often ask you to send bills and records, and so you do that. At that point, the lawyers, the plaintiff attorneys, will make a demand letter. It's like a packet, and they will send that to the insurance company. So you'll often hear that from the attorneys when you're in practice, that, oh, we are sending a demand letter soon, we need everything right away. And these are the words that you'll hear a lot. So most cases, about 95% of the cases that will, that you'll see will settle at this stage, maybe more than 95. Let's just say 95, approximately 95% of the cases will, will be done. They'll settle. It's good. You will never have to worry about your documentation. Hopefully you get paid, but yeah, it's done. If not, the next stage is mediation and arbitration. This is again not litigation, but can get complicated depending on the jurisdiction that you're working under. But long story short, again, it's not full-blown let's litigate this case in court. They're both arguing. Plaintiff attorney is trying to talk to the insurance adjuster at this point and trying to negotiate. So it's still mediation arbitration, this process where sometimes the other side, meaning the There may be a defense attorney at this point. Both sides are meeting and trying to reach a resolution. Nobody wants to take cases to the court, even attorneys, because it's expensive. So people try to settle again, very likely at this stage, but sometimes negotiations fail. So now let's talk about litigation. You will know that a case is in litigation when you will start getting— and I want to use this word— harassment. From a lot of third-party records retrieval companies. If you practice personal injury, you know what I'm talking about. For those who don't, you will start getting third-party companies asking you for bills and records. And this is not from the patient's attorney side. This is just random. There's companies for that. So basically, the defense side is hiring this third-party records retrieval companies, and they'll start sending you subpoenas for documents and things like that. So, you know, okay, this is your first time knowing that this particular case is in litigation. Besides that, there's no way for you to know that because you're so busy in your practice. You're not going to call the law firm and say, hey, what's going on with this? But once you start seeing that, you know that, okay, maybe Right now they're just asking for documentation, but if they don't settle, there may be a point in the future that I may have to go and testify either through deposition or in trial. Then comes the deposition segment. Again, most of the cases do settle even in the early phases of litigation, but there is a process called discovery, meaning at this stage Both parties are now exchanging evidence that they have, and this is the time in a case where depositions are being taken. So there's two types of deposition: there's written deposition questions that you will receive, which which is DWQ, and it's mostly yes and no answers, or they may be asking you to produce records. Again, there's no live testimony here. And chiropractors are not afraid of this. It's normal business. Your staff can do all of that. They can answer the DWQs. They can do affidavits. Make sure you verify information. We want to know what information is being sent out by your staff, but it's not generally stressful. And then comes the time when you have to be deposed. Now, if the plaintiff attorney, meaning your patient's lawyer, wants you to give an expert testimony, they'll reach out to you generally via email. They'll ask you for an invoice, make sure you bill them for your time. And this is separate from whether or not the lawyer receives a settlement and then you get paid on the LOP. This is separate. This is for your time to give a testimony. So that's plaintiff attorney usually asking you via email, and you can negotiate your, your price per hour with them, all of that separately. They'll set a date aside for you to present Your deposition, and we'll talk about depositions later, but sometimes you can get subpoenaed, meaning the other side will issue a subpoena to compel you to testify. When that happens, it's not coming from your patient's attorney. It's coming from the other side, and they are not going to pay you for that. Practice tip that has happened to me. And I— whenever you get the subpoena, they— somebody will come and deliver it to you, and it'll have on that subpoena, if you read it, it'll know who's suing who. And you know that you're not party to the case because you're not being served, you're being subpoenaed, you're coming in as a witness. So your name's nowhere on the document. I mean, as far as parties are concerned. And then you'll see what they're asking in the subpoena. They're asking you to give an oral testimony. And they may also ask you to bring documents, and it'll have the lawyer's name on it, both for the plaintiff and the defense. So you know that this is coming from the other side and not from the patient's attorney. You can always email them and ask them to compensate you for your time. Again, it's hard because they are not legally required to pay you, the defense side, but A lot of the times they'll say, sure, doctor, how much do you charge? And they'll negotiate with you and then you can, you can reach an agreement, but you have to do a little bit of persistence, confidence, and tell them you're busy because we are busy. Again, settlement can reach at any stage, so they may set a date for you to do your deposition, but they can settle before that. They can settle right after your deposition. You never know when the case is going to get settled. Sometimes Even before the jury, like right after closing arguments, a case can settle. So settlements can happen at any stage. So just be mindful of that. Just because you are, you have a trial date and you take time off of work and all of that, and you may even show up to the court and they settle that morning. So I always tell my chiropractor buddies, like, if you are going to go to court and you're taking time off, You have to ask for your money for your time, even if they settle. So that's something that you have to negotiate with the plaintiff side. Of course, the defense is not going to negotiate with you. They don't legally have to, but most of the time your plaintiff attorneys will say, sure, we understand things happen. So communicate with them in writing and make sure that you are compensated, cuz this is not part of your LOP. This is extra. And know your worth. All right, let's move on to tort law basics. Negligence. You will not hear these terms in practice, but it's good to to understand what's going on. So when a driver messes up and causes an accident, you can bring a lawsuit against that driver and bring their insurance company into that case with the vehicle of negligence. That is the legal cause of action. And in order to prove negligence, a plaintiff attorney has to prove 4 things: duty, breach, causation, and damages. Duty and breach is something that the lawyers have to worry about, so I'm not going to get into that. But just to explain, your duty would be, it's my duty to be careful when I'm driving, and I breach that duty if I don't follow the rules, the traffic rules. So that's how they bring those elements and evidence for those elements in courtrooms. Where you and I are going to get challenged as chiropractors is causation and damages. So the other 2 buckets, causation and damages, that's where majority of our testimony will come into play. Causation is the number one battleground. Every defense attorney will target you and your notes when it comes to causation. They want to make it sound like the accident did not cause this injury. Every case, they'll say it's preexisting, it didn't happen from the accident, that we're exaggerating, or the client or the patient is exaggerating. That's what the defense will say every single time. It's a given. So causation is a battleground. You will use your notes to link causation. They will use your notes to make it sound like causation is poor or there's no documentation for causation. So remember, causation, very important. A lot of the chiropractors don't, don't document causation at all, and we'll get into that later. Damages, again, not a battleground for sure, but not that difficult to prove. This is where your bills come into place when they say bills and records. The records goes towards causation. The bills are now used to prove damages, and not only just your bills, but entire whatever the patient did, whether they any ER record, any medical doctor, any anybody that they've seen, all that becomes past medical damages. Then there are other types of damages that the plaintiff can bring. Future. There's past medical and there's future medical. This is when somebody is severely injured that they're going to need maybe 24/7 nursing facility, things like that. I'm just giving you examples, but there is also what's going to happen in the future. So past medical are your bills. Future medical is speculative in so many ways, but a clever attorney will try to make make that evidence come in and get compensation for what will happen in the future. There's other types of non-economic economic damages, which again, you don't need to know from your perspective, but it's always good to know overall what happens in a negligence case. So let's talk about causation. Clinical causation is very different from legal causation. So when— what we study in school about causation, if somebody has radiculopathy, then you're thinking, okay, it may be a disc injury there. So that is your clinical causation. Legal causation is proving that whatever injury or symptoms this patient is presenting with is directly linked to this particular accident. And it's easier said than done because clever defense attorneys will, like I said, they, they have ammo. They'll use everything in your notes, any kind of past medical history to say this is preexisting, all sorts of stuff. So what can we do to make our, our documentation better? You have to link the injuries to the accident. So if somebody got into an accident yesterday and they presented with neck pain, don't just say they got into an accident, they came with neck pain today, because you see, there is this missing piece of evidence there. You have to say they got into an accident on this particular date, and because of that accident, they are presenting with pain today. So just simple word connecting those 2 sentences now helps your notes look better as far as causation is concerned. That is because of this accident, the patient is presenting with these symptoms. So causing, like the causation aspect, very, very important document. Make sure you document mechanism of injury. A lot of us don't do that. We just say patient presents with neck pain, back pain. mechanism of injury because of car accident. Also, if there's any extremities involved. For a regular spine injury, neck and back, it's sort of implied at this point that if somebody has a car accident injury, whiplash injury, that it's neck and back. So we don't have to worry too much about explaining neck and back pain. But if they have knee pain, shoulder pain, ankle pain, You have to go a step forward and document that why. So always good practice to ask your patients, did you hit your knee to the dashboard? Or if they present with wrist pain, explain, well, where was your arm or your hand? Was it on the steering wheel? What happened? Get that information from, from the patient and, and document it. If they give you that information, do it. If they say, Oh, I, I don't remember, but it hurts. Then you can always document that. Don't remember exactly what happened. The accident happened too fast, but did not have any pain before the accident. But now, after the accident, they said that their wrist is hurting. And so that helps. Be truthful, but be persuasive when you're writing. Now, Timing of symptom manifestation, again, linked directly towards causation. It's important that most of the time it depends on the case. If you have a case that the accident happened recently and you saw them 2 or 3 weeks within that timeframe, it's implied the timing is easy. That's a good, good story. But you'll get cases in practice that accident happened 6 months ago and they're having pain right now. There's not much you can do about that as far as documenting causation, but you can say Ask the patient, what did you do for this gap, that 6 months? Did you treat at home? What happened? Why were you not able to get treatment sooner? And they'll tell you, oh, I didn't have transportation. I didn't have that. It's okay to document that. Like I said, be truthful, but these are the questions that you can ask your patient and it'll make you not a regular chiropractor, but a well-informed chiropractor who understands how to alleviate or increase the value of their notes. And so what you ask in your history matters. It's not a cookie cutter, let me just ask all this accident questionnaire. No, no, no. Think, look at the date of the accident, see if there's gaps. Try and see if you get information out of them to kind of connect causation there. It'll make your notes more valuable. Acute versus chronic symptoms. This is, this is so common. Every defense attorney will say this is not acute, this is chronic. That's where your orthopedic testing, your palpation skills, everything will come into play here. You, you're doctors, you know how to document acute versus chronic, but also know that in real life we get our plaintiffs the way we get them, meaning every patient will have preexisting conditions. And it's okay. It's fine if they have car accidents in the past. It's okay to document that. But then you can also document, sure, they had accident previously, that there is history of car accident, but they didn't have much pain before this accident, and this accident exacerbated their symptoms. So one sentence can now say, sure, my patient is 65 years old and had some arthritic changes in the spine. But it's doing fine. And now after this wreck, and if they are feeling exacerbation of symptoms, then say that, document that. So connecting again to causation will help you make your notes stronger. And that testimony is now backed up by your notes. History of past pain, prior collisions, very, very important. There's no such thing as hiding a bad fact. Like I said, a lot of our patients will have multiple car wrecks or they're older, they've got other Comorbidities and other issues going on. Defense will point at that, and it's fine. Let them. You can always say they had those issues, but this accident exacerbated their symptoms, which they did. And the next in line is this particular phrase: reasonable medical probability. Very, very important phrase. Every time a defense attorney asks you in person or in trial or Off the record. So, doctor, are you sure? Are you sure that this injury is caused by this car wreck? Are you 100% sure? Well, let me tell you, doctors, you don't have to be 100% sure. The legal standard is reasonable medical probability, meaning more likely than not, meaning if you are about 70% sure that this type of symptoms will manifest after a car accident, you have everything that you need to, to give that statement. You don't have to be 100% sure that all these injuries are because of this accident. You just have to be more likely than not sure. So the standard is reasonable medical probability, and that you can say that with confidence. No one can be 100% sure. Can you be sure enough? Yeah, I have reasonable medical probability that my patient's symptoms stem from this particular injury.

That wraps up part 1 of our conversation with Dr. Pengti Fadhiya. In this episode, Dr. Fadhiya gave us a clear look at why personal injury documentation requires more than just checking the right boxes. Your notes tell the story of the patient's injury, the mechanism of injury, the progression of care, the clinical reasoning behind your treatment plan, and ultimately, it provides credibility for you as a provider. One of the biggest takeaways from this first part is that documentation is not just about proving what you did. It's about clearly connecting the dots between the accident, The patient's symptoms, your objective findings, your clinical decisions, and the patient's functional progress over time. As Dr. Fadilla emphasized, causation is often one of the biggest battlegrounds in personal injury cases. That means the way you document history, mechanism of injury, symptom onset, preexisting conditions, functional limitations, gaps in care, and treatment progression all matter. In part 2, we'll continue the conversation by moving deeper into subpoenas, affidavits, depositions, trial testimony. We'll talk about expert witness credibility and the ethical issues chiropractors need to be aware of when working within the personal injury space. So if this episode already has you mentally reviewing your own documentation habits, good, that's the point. Better notes today can save you a world of stress If you found value in today's training, be sure to like, follow, and share it with a friend or a colleague. And check out the show notes for any special offers from our sponsors, along with a link to our website at factorpodcast.com. That's F-A-K-T-R podcast.com, where you can view a full transcript and get access to the recorded replay of this webinar if you're more of a visual learner. Be sure to join us for part 2, where we'll talk about what happens when your records are no longer just sitting in your EHR system, They're being examined, questioned, and potentially used in court. Part 2 drops in 2 weeks. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings, as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.