 So hi everyone and thanks for joining Patient Safety Movement Foundation's World Patient Safety Day event. My name is Yolie Flamaredes. I'm the social impact advisor for Lilliton Road Productions. And I'm with some of the very talented cast of the show Dr. Duff, as well as the executive producer Patrick McManus, who's also the showrunner and head of Lilliton Road Productions. So we're going to have some questions for the cast and Patrick, but I'm going to let Patrick provide a brief synopsis of Dr. Duff before we get started. So Patrick. Sure. So Dr. Duff is the story of Dr. Christopher Dunsch, who was a neurosurgeon in Dallas, Texas. He did his studies at University of Tennessee and then his fellowship at SEMS Murphy. So he was trained in some of the best hospitals and schools in the country. He, when he moved to Dallas, Texas, he began his time at Baylor Plano Hospital, where he, where, as we've said, sort of his reign of terror in Texas actually began over the course of what was approximately a year and a half or two years, he ended up either maiming or killing 33 out of 38 of his patients. And he was moved from hospital to hospital from Baylor to Dallas Medical and to University General and and onward. And it wasn't until Drs. Robert Henderson and Drs. Randall Kirby, both of whom were also was one was a neurosurgeon and one was a vascular and access surgeon came upon Dr. Dunsch's work that anybody began to really pay attention and try to set out to stop him. Both Drs. Henderson and Dr. Kirby, they approached the Texas Medical Board in order to try to stop him. So I know for myself, I was not very familiar with these topics prior to watching the show and working on the campaign. And I was wondering what kind of assumptions all of you had about your care in general, and about the medical care system and how did that change as you went through the process of reading the scripts and being part of the show. When I started the show, I really didn't know anything about the medical system, I didn't. I trusted it I hadn't had a lot of interaction with doctors or the legal system. And so when I listened to the podcast for the first time, it rocked my world because I first of all, I hadn't heard of the story before. I was horrified that Dr. Dunsch went from hospital to hospital and no one like I didn't understand. And still it frustrates me, it rages me that he was able to navigate and people protected him because they wanted to protect their brand, they wanted to protect themselves And then after talking with Michelle sugar and realizing what a process it was I mean the case took over two years. How many puzzle pieces there were all the hoop she had to jump through the evidence like she really had to obviously prove her case because it was a criminal case, but she shouldn't I mean the evidence was all there. Like it's the whole criminal trial shouldn't have even happened. It should have been prevented before by the people who had empowered him, you know, if they see that one patient died do an investigation report him. That information should have been accessible to all of his patients. And so now, obviously we're living in a time where the medical system is so important. And they have done so much for us, especially this past year, but I think the key as we all know is transparency and being honest about what are the flaws in this system and reckoning with that and improving that rather than protecting the people in power and the people who have money, because the people on the medical boards, they're politicians they're people with a lot of influence there it's a, it's a brand. It's not about the patients it's not about the victims. And so, once this show was released I was able to talk to Dr Henderson and Dr Kirby and Michelle in person and it was harrowing and also terrifying to hear that these problems are ongoing that this is not this is a fight that they're continuing to fight. And it's so complicated. It's not like you need experts to help guide individuals through this because it's not it's not a it's a tricky system and it's meant to be tricky, so that it's not sort of that the power it stays that people in power stay in power. We think about the medical system as something that's very personal and individualized and now this exposes the entire system and that's what you're thinking of, which is really amazing. Hebert what about you any initial reactions. Yeah, I mean, I think sometimes with something that's based on a true story. As an audience you look at it, and the the issue has sort of been solved. But I think that is one of the most scary things about this story, in particular is that it is like Sophia kind of touched on where it's still in the process that they're still working on patient advocacy and different ways to help prevent some of these types of issues. So, to sort of go back to the, you know, so the beginning of the question is, I didn't think that much about the medical system before I got involved with the show, I was, I've been fortunate enough to not need any surgery to not have anything extreme happen to me so I had a lot of trust and I assumed that patients were always the priority, and working on this really sort of burst that bubble and really taught me about. You know, in this, in this particular case, you know, an extreme case where things can go really awry people, many people, many people can get hurt and die. When someone is being protected from this, from this system. Yeah, I mean, I you'd hate to think about trust being broken, but it doesn't make you reevaluate how you trust and how you understand the way the system works. I think that what what what wasn't is always surprising to me anytime that I have to interface with the American medical system. And I've actually had to unfortunately do that quite a bit this summer. Actually, over the course of last year, one having a small child, and I've been going through a medical issue with my back is the level of paranoia that I have to feel around whether I'm receiving a standard of care that is based upon my particular needs or whether I'm receiving a standard of care that's based upon financial necessity for the doctor, the lab, the hospital and growing up inside of the Canadian system where the the onus and the benefit is patient focused. It has always been surprising to me when I'm down here and to sort of pick up what Anna Sophia was saying, the, there's a massive gulf. And unfortunately, we as patients get lost in this space in between between the standard of care that possible that is available. If you have access and the amazing work that practitioners are doing doctors and nurses are doing to bring treatments and therapies at the very cutting edge of what's available anywhere in the world. That is a reality of the American medical system. And then another reality of the American medical system is that it because it's so geared towards being a for profit system. Our bodies are often put through unnecessary tests and trials and the standard of care is built around that profit motive. So I threw Dr. Death and also before Dr. Death and post Dr. Death. I'm always surprised here in the States, how much is incumbent upon me as a patient to to have to fact check and second guess my care providers, which, you know, in an open market, I think it makes sense to to do your research. But I've never really believed that when you are a patient, you are actually part of a market economy because we don't know, we're not highly specialized as patients, and you're in an incredibly vulnerable position. You're going to your doctor to your care provider to try to help you with an issue small or large that is serious enough for you to seek out help for it. And then we're put into a position to be at the same time patients and and capitalists right and and market testers. And that to me is just a massive breakdown inside of the the system and its ability to provide best care to its patients. Yeah, you never have to think about being a self advocate right typically and here at this point when you when you come to this juncture where you realize what the potential is here you think oh I need to do my research and I need to understand what's going on and what the financial interests are I think those are all great. It's beyond just even though it should be done it's beyond just get a second opinion right the problem is not just that you need to have a second set of eyeballs on whatever the issue is. The problem is that even the best and most well intentioned practitioners inside of the American system have a financial burden that they have to satisfy. And so they whether it's conscious or unconscious and I'm willing to believe that it's both a lot of the time right they are they are motivated required by the design of the system to put your body through a maximalist course no matter what it is. And that's not always the best standard of care. And that puts the patient then into this place yeah where we have to be we have to be we have to be acid testing all of the the care that is potentially being provided towards us as though we were subject matter experts. And I'm sure the Canadian system isn't perfect right but but it is certainly closer to what the ideal should be which is to put the patient forward because I am not a subject matter expert on basically anything period and anything that's going on in my body. And to ask me to be to to suddenly have you know to gain that wisdom or to God forbid do a Google search which I think happens way too often right in order to make sure that I can make in order to ensure that that I can hold my care providers to account should they be prescribing or recommending things that are really only to the benefit of the bottom line and not necessarily to the benefit of my health. Yeah I mean a lot of that onus is now placed on the patient and you come to understand the way it works. You know and a lot of this like you're talking about research and one of the things I've heard many of you mentioned. In your interviews is the like the significant amount of research that the that Patrick's did the writers did and I was wondering what struck you guys most about how that research was adapted for the broader audience for massive consumption and Patrick if you could speak a little bit more about that research process and how you guys came to terms with all of this systemic and structural problems and balancing that desire to both entertain and educate audiences without kind of like hammering them on the head or obscuring all this information that is actually quite valuable and even for the cast you you see this like evolution and their understanding of the way things work. So I don't know if any of you want to jump into that fray. Do you want me to start just because I started doing the research and I'll be very brief because it's very simple as am I. You know I those who know me best know that I am not good at the maths and the sciences. It's not my strong suit and so it was extraordinarily challenging for me when I first was handed over the material. Just again it's thousands and thousands of pages and depositions and terms that I had never heard of nor will I ever hear of again and and what I knew was that I had to find a way to do two things. I had to figure out a way to tell a story that I would be able to understand. At the same time telling a story that was complex enough that people who do this for a living would be able to also see that we that we were trying to bring some verisimilitude to the table right. And so you know I I personally found the process of digging through it to be akin to what I would imagine just you know leapfrogging off of what Josh was just talking about what patients would have to do if they were put into this position. I am someone who freely I'm a lemming I absolutely bought in bought by into the medical system hook line and sinker I outside of the fact that I do Google searches and find out that I'm dying of everything on a daily basis. I say to the doctor you I pay you to tell me what's wrong with me I don't know what's wrong with me and and that I only through the course of researching this project and then obviously delving into it in the writer's room and then through the production did I realize how ultimately deadly that could actually be for me but so that the long and short of it is the fact that I really felt like it was it was incumbent on us to be able to reach a broad audience with very complicated with a very complicated story and background and that is that's difficult to distill and thankfully I had a bunch of writers around me who were smarter than I was who helped me do to do that. And Sophia you played the ADA Michelle sugar which is another kind of highlight where you talk about where you begin to like run through the issues of the show and grapple with the criminal elements of what was going on. And in that process we see you face a lot of obstacles that to pursue the case in the first place. I was wondering what other elements that you learned about whether they were political legislative. Did you come to find or maybe designed to inhibit the pursuit of justice for patients I don't know if you guys talked about this in your discussions. We talked. I mean, Patrick gave so much research so much information that was. I was really grateful for it because it was easy to understand and after talking with Michelle and even learning more about patient safety after the fact it's not easy to parse through. So there there was another podcast called the great trials podcast and that Michelle spoke on that and she really gets into the case from a more like criminal perspective and it's all lawyers talking so if anybody's interested highly highly recommended and then also there was a civil suit going on at the same time. I found it very helpful to learn about. Oh my gosh, who's a lawyer's name. What's your name. Kevin way. Like who's a legend. And what she has to do to advocate for patients because I think what I really learned is that The system is sort of well like in Texas and we briefly touch upon it in the show there's a statute. Preventing doctors from being sued for over $250,000 and so if you are a patient and there is a malpractice it's almost impossible to have somebody represent you because you won't the lawyers won't make much money they get half of whatever the 250,000. Is and then your whole life might be affected and so what I really learned from the show and from talking on the show is that that statute was passed and the people of Texas voted on that statute and it's incentivizes businesses it incentivizes doctors it protects it's it's but it but it wasn't something that's easy to understand you know we go to the voting booth and unless you do an insane amount of research and are constantly googling and maybe fact check it with experts. It's hard to understand what that means what it is that you're voting on it might be sold to you as hey there are going to be more doctors in the state of Texas and there you're going to incentivize all these great doctors there's going to be medical research and whatnot which is true, but then there are also there's a flip side and so I think I didn't really I didn't connect the dots before of how intertwined the legal and the medical and are voting how legislative system everything is combined and it just it overwhelmed me it continues just like Josh was saying I want to say Joshua Jackson because there is your full name on the zoom it's good it's the alliteration you know I was speaking with Dr Henderson and he was mentioning kind of what you were saying Josh just doctors he said the medical system has changed so much in the last 10 years because of insurance companies and what they will and will not cover and how it's all about it's no longer about the patient and he was just saying if a patient comes in he runs a diagnostic he can see what's wrong with them he writes what he thinks should be done maybe it's simple it gets sent to another doctor and that could be a pediatric doctor like somebody who's not connected with that expertise and there are so many steps it's made it a lot more complicated for doctors to have relationships with patients or they you know their insurance changes every two years something happens where having a relationship with a doctor it for a long period of time is is becoming less and less the thing so you don't have as much of those those relationships where they know your body and whatever you need done is covered by your insurance so yeah it's sort of the wilderness yeah because there you're talking about a bit of a fragmentation of care whereas you know the realization is that it's not just about the medical system like you just said it's about politics and law and becomes you realize what a web it is yeah the patient's safety the resources I think like in light of what Josh is talking about and people not knowing where to go I think the best thing is this like the solidarity and knowing that when something happens being able to report it or being part of a community that will help you find the right people and that's obviously patient zero that's I'm trying to remember all the names of the different resources but there there are places to go and I think like the more that that is shared the the easier it is to have people empowered because if everybody's experienced some sort of malpractice and how to negative impact but they know the places to go then that creates more of a voice for the people that can put pressure on the institutions which is what I really found valuable and kind of the only silver not silver lining the only hopeful part at the end of this was that little that you guys have a conversation that you welcome it after the show and that there are these resources because it's there and I didn't know about literally any of them. So that that is available. Yeah and I mean to throw it back at PSMF they were a huge resource for our campaign to I think bringing together all of these pieces and really focusing on the patient and how to empower yourself when you want to see your doctor go to the hospital or super valuable and their partners to are just excellent resources so thanks Anna Sophia for bringing that up I think it's really important. I think you guys provided excellent insights based on the show and your own experiences and perspectives on the bigger issue of patient safety and how you were able to kind of digest and and you know manage these ideas and concepts and I feel very lucky to have seen the show and to have began to understand these issues and I and I hope that the people who watch Dr. Death begin to kind of grapple with them as well. But I think we're at time I really again thank you guys so much for everything that you gave here and all your insights I think they're super valuable.