Doc Sues Patient's Family and Wins

Urologist Arnaldo Trabucco, MD, was outraged when he learned of a legal claim filed by a patient's family blaming him for the patient's death.

Trabucco had performed a successful laparoscopic left radical nephrectomy on Gerald Scharf, but he died 3 days later from an unrelated condition, said Trabucco, who now practices in California. The claims alleged not only wrongful death, but also that Trabucco "committed willful and malicious actions upon" the patient, eventually resulting in his death, and that Trabucco's actions constituted "extreme and outrageous behavior."

The accusations were levied on behalf of the patient's family by a bankruptcy attorney who admittedly had no experience in medical malpractice litigation.

"It was a vicious allegation that I intentionally tried to kill my own patient," said Trabucco, 66. "It's an allegation that was outlandish. Those were fighting words."

As the case dragged on, Trabucco filed a complaint against the Scharfs and bankruptcy attorney Jeffrey Cogan for malicious prosecution and abuse of process. In 2018, Trabucco prevailed when a jury awarded him $6,232,000 in compensatory damages and $1,768,000 in punitive damages against Cogan. (No damages were assessed against the patient's family.)

"This was a principle issue more than anything else," Trabucco said. "My name was tarnished and thrown through the mud. I'm very proud of my name and my reputation."

Cogan, a bankruptcy attorney licensed in Nevada and California, disputes that his actions were malicious and disagrees with the jury's verdict.

"I don't think I did anything wrong with filing the lawsuit," he said.

Despite the $8 million award, the legal fight between Trabucco and Cogan has continued — and is not over yet.

Not Your Ordinary Legal Journey

Arnaldo Trabucco completed his medical training in Rome, Italy, before moving back to the US to begin his residency in Brooklyn, New York.

He quietly practiced urology in New York for years before moving to Columbus, Indiana, to work at a urology clinic. In 2005, Trabucco made headlines when Bartholomew County, Indiana, sheriff's deputies found marijuana plants growing in his home. His medical license was suspended, and he pled guilty to a misdemeanor.

Trabucco said he was unaware that a family member was growing the plants in the home and that he was not responsible for the operation. The misdemeanor has since been expunged from his record, according to Trabucco. Bartholomew County records do not list the offense. He later moved to Arizona, where he opened a medical practice.

Before the Scharfs filed their malpractice case in 2013, Trabucco had been embroiled in a series of unrelated legal disputes, including post-divorce proceedings and a complaint against him by another physician, alleging defamation. In that case, the physician claimed Trabucco published false and defamatory communications about him, including that the physician committed intentional fraud.

Trabucco filed his own suit for defamation and infliction of emotional distress against the same physician for alleged threats and harassment and making false reports about him to several Arizona state entities. The defamation suit against Trabucco ended in a settlement, the terms of which are confidential, according to Cogan. Trabucco's defamation case against the physician was dismissed, according to court records, but they do not specify the reason. Trabucco said he dropped the defamation case because of the other relentless litigation he was facing.

In November 2012, Trabucco filed for Chapter 7 bankruptcy protection.

Cogan was representing Trabucco's ex-wife's interests as a creditor in the bankruptcy proceeding and eventually represented the physician who sued Trabucco, according to court documents. In all, Cogan represented six creditors in connection to Trabucco's bankruptcy, including the Scharfs. He also took over the Scharfs' malpractice case in Arizona's Mohave County Superior Court after their attorney died.

As part of a filing in Nevada bankruptcy court called a "Complaint to Determine Nondischargeabiliy of Debts," Cogan alleged that Trabucco knew he lacked sufficient expertise regarding the laparoscopic nephrectomy, that an intraoperative complication occurred due to his error, and that Trabucco hid the complication and did not attempt to remedy the situation, among other claims.

In addition to the Mohave County filing and the bankruptcy filing, Cogan filed a similar medical malpractice case against Trabucco in Arizona district court.

"I believe, based upon the statements by [a retired medical malpractice attorney], that Dr Trabucco squeezed the abdominal aorta," Cogan said. "When he did so, plaque from Mr Scharf blocked blood from going to his remaining his kidney, causing his death. My lawsuit said that Dr Trabucco knew he made a mistake and went home rather than fixing the mistake."

Trabucco said the laparoscopic nephrectomy went smoothly. A few hours after the surgery however, Scharf was transferred to a Las Vegas hospital with a diagnosis of potential occlusion of the abdominal aorta. Surgery was performed, and while the operative report noted the presence of severe atherosclerosis of the abdominal aorta, there was no indication of an intraoperative injury to the aorta from Trabucco's surgery, according to court documents filed in US District Court for the District of Arizona. An autopsy performed on Scharf reported "severe calcific aortic atherosclerosis, primarily at the aortic arch and abdominal aorta at the level of the branching of the renal arteries with small adherent thrombus." The autopsy did not include any indication or suggestion of an intraoperative injury to the abdominal aorta.

A federal jury found unanimously in favor of Trabucco, concluding that he did nothing wrong. The original medical malpractice case in Mohave County court was ultimately dismissed and in 2014, the bankruptcy court entered an order discharging Trabucco from all pre-petition debts, according to court records.

Meanwhile, as the malicious prosecution case against Cogan continued, Trabucco's name again drew media attention. His former girlfriend was arrested for plotting to kidnap and kill an attorney who was representing Trabucco's ex-wife in a divorce proceeding. Renee Perillo was sentenced to 27 years in prison for conspiracy to commit kidnapping and murder for hire for trying to kill Noblesville, Indiana, attorney Rebecca Eimerman. Eimerman was pursuing divorce settlement money from Trabucco on behalf of his ex-wife. Perillo's son was also charged in the crime.

No charges related to the crime were filed against Trabucco, according to the Hamilton County Prosecutor's Office and federal charging records. Trabucco said he was not involved in the incident and had no knowledge of Perillo's plans.

A Hard Fought — and Still Continuing — Legal Battle

After a 3-day trial, jurors in 2018 found that Cogan owed Trabucco $8 million for the harm caused by the unfounded claims.

"This has had a tremendous impact on my life," Trabucco said. "It's cost me a lot of time, money, and anguish."

Cogan appealed the verdict. An Arizona appeals court in 2020 upheld the finding of liability for malicious prosecution against Cogan, but it vacated the finding of liability for abuse of process. Because of the partial reversal, the appellate court vacated the $8 million and sent the case back to the Superior Court in Mohave County, Arizona, for a new trial on damages.

But shortly before the December 2021 retrial, both parties agreed to settle for $8 million.

The settlement, however, is not the end of the litigation between the parties.

Late last year, Cogan filed a new case in the US District Court for the District of Nevada against Trabucco alleging the Arizona court that tried the malicious prosecution case never had jurisdiction. Cogan contends that per federal case law, any damages resulting from a bankruptcy court pleading give the federal court exclusive jurisdiction over the matter.

"I believe that I will win the federal court case," Cogan said. "If Judge Andrew P. Gordon finds for me, Dr Trabucco's judgment in Arizona is void as Arizona did not have subject-matter jurisdiction."

Trabucco says the new federal case has no merit.

"The federal courts have no jurisdiction over civil matters, and this should be thrown out," he said. "However, my attorney is fully prepared to take this to the Supreme Court [if it moves forward]."

At this article's deadline, the judge had not yet ruled on Trabucco's motion to dismiss the federal complaint.

Should a Physician Sue for Malicious Prosecution?

Trabucco's case raises the question of whether physicians should consider suing a patient after winning their malpractice case. As many doctors know, a successful case outcome doesn't necessarily undo the time spent, income lost, and reputation harm that often comes with a negligence lawsuit. Is suing for malicious prosecution a reasonable route to recoup some of the damages caused by the claim?

"It's an uphill struggle to prevail," says Jeffrey Segal, MD, JD. "Have people done it? Yes, they have. Is it easy? No."

A physician must hit the marks of a distinct checklist to pursue a malicious prosecution case, said Segal, CEO and founder of Medical Justice, a company that aids and advises physicians on legal matters. One necessary element is that the malpractice case against the physician must have been adjudicated on the merits, he said. For example, the doctor won the case at trial or the case was dismissed on summary judgment. Summary judgment refers to a court tossing the claim because there was no genuine dispute as to any material fact and because the defendant is entitled to judgment as a matter of law.

If the case was dismissed for another reason, such as a technicality, or dropped by the plaintiff, the case would not meet the threshold for a malicious prosecution claim, Segal explains.

The physician must also show that the lawsuit was instituted with "malice," meaning with an intent to hurt the physician, and that the lawsuit was brought without "probable cause," adds J. Richard Moore, JD, a medical malpractice defense attorney based in Indianapolis, Indiana.

"The courts are still pretty good at weeding out cases with no merit whatsoever, so even if a physician takes a case to trial and wins, it is exceedingly rare that a case that makes it that far, has no merit whatsoever," Moore said.

In addition, a plaintiffs' attorney may be protected from a malicious prosecution claim because they relied on a medical expert's opinion that reasonable cause existed to file a lawsuit, notes William Sullivan, DO, JD, an emergency physician and attorney based in Frankfort, Illinois.

Sullivan has personal experience with such a challenge. He filed a malicious prosecution claim against a plaintiffs' attorney after being dismissed from a medical malpractice case. The claim stemmed from Sullivan inserting an emergency central line into a trauma patient who was taken to surgery and later died. The suit alleged Sullivan failed to diagnose internal bleeding and failed to perform surgery, although surgeons at the hospital knew internal bleeding was present and Sullivan had no privileges to perform surgery, he said.

However, Sullivan was unable to identify the medical expert involved in the claim. Illinois law allows a malpractice plaintiff to withhold the identity of a medical expert who certifies a malpractice lawsuit. Because Sullivan couldn't identify the expert, he could not depose the physician, and the law firm claimed there was no malicious prosecution because it relied on the trauma surgeon's opinion that Sullivan was liable.

The trial court agreed with the law firm's argument and dismissed them from the case, Sullivan said. The trial court also agreed that the expert trauma surgeon should be allowed to remain anonymous in accordance with Illinois law.

Alternative Options for Doctors to Recover Damages

For physicians who want to recoup after a frivolous claim, but don't want to dive into another lawsuit, there are other options, say legal experts.

One alternative is filing a motion for sanctions, Sullivan said. If an attorney files a lawsuit that does not have a reasonable basis in fact or law, that attorney could be subject to sanctions, including paying for the physician's attorney's fees and costs, he explained. If a motion for sanctions is granted against an opposing attorney, that fact may be reportable to the attorney's insurance carrier and also reportable to the attorney's state licensing board. A motion for sanctions does not require filing of a separate lawsuit and filing a motion for sanctions may allow the defendant physician or the defense attorney to depose the plaintiff attorney regarding the reasonable basis that attorney had for filing a lawsuit, Sullivan said.

Sullivan recently represented a physician who won a motion for sanctions. During the legal action against him, Sullivan presented the plaintiff's attorney with information showing why his lawsuit did not have a reasonable basis, but the attorney repeatedly ignored the information, he said.

"Eventually, I filed a motion to dismiss the physician from the lawsuit and that motion was granted," he said. "I also filed a motion for sanctions so that the physician could recover the costs involved in defending the claim. The trial court granted our motion for sanctions against the plaintiff and her law firm and awarded my client more than $10,000."

Physicians who believe a plaintiffs' attorney is acting unprofessionally can also file a complaint with the attorney's bar, Segal said. And expert witnesses acting in bad faith can be reported to professional societies, medical licensing boards, and/or specialty boards.

"There are a number of avenues to address the sense of justice," he said. "But if you're looking for a payday, the only way to do that is by going to court."

Alicia Gallegos is a reporter for Medscape Business of Medicine based in the Midwest. She has previously written for the American Medical News, the ACP Internist, and the AAMC Reporter. Contact Alicia at agallegos@medscape.net or via Twitter at @Legal_med.

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