Eric Weitz

The term “nuclear verdict” gets used to describe large jury awards as if they are irrational or out of control. It isn’t neutral language, it’s framing. It shifts attention away from what caused the harm and onto the size of the result. It suggests the problem is the jury, not the underlying conduct. What often gets ignored is that these cases involve catastrophic injury, lifelong care, or death. Juries aren’t reacting to headlines, they’re responding to evidence. Calling it “nuclear” doesn’t explain the outcome. It attempts to discredit it.

Medical error is often framed as something that happens to “other people.” It doesn’t. While vulnerable communities may face higher risk due to access and systemic disparities, no level of education, income, or influence creates immunity. Serious mistakes occur in every type of hospital, across every demographic. The common thread isn’t the patient. It’s the system. Believing you’re protected by status is comforting. It’s also dangerous. Because the risks in healthcare are not selective, and they are often invisible until it’s too late.

Healthcare doesn’t lack guidance on patient safety. The Institute for Healthcare Improvement Patient Safety Essentials Toolkit lays out clear, evidence-based practices, from leadership accountability to frontline communication and system design. The problem isn’t knowledge, it’s execution. These tools only work if they’re consistently applied, resourced, and reinforced in real-world conditions. Without that, safety becomes a policy, not a practice. And patients pay the price.

High-stakes litigation has always favored scale. Larger firms have more people, more resources, and more time to process complex records. That’s starting to change. With AI, thousands of pages of medical records can be analyzed in hours instead of weeks. Patterns surface faster. Gaps become clearer. Relevant literature can be identified and tested in real time. It doesn’t replace judgment, it enhances it. For boutique firms, that shift matters. It allows smaller teams to operate with a level of speed and depth that was previously out of reach, and compete where it counts.

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Event reporting systems are supposed to be the backbone of patient safety. Most hospitals have them. But that doesn’t mean they work the way we think they do. In theory, these systems allow frontline clinicians, nurses, pharmacists, and physicians, to report safety events, near misses, and unsafe conditions. When they function properly, they can reveal patterns of risk and help organizations prevent harm before it happens. But the reality is more complicated. Voluntary reporting systems capture only a fraction of the events that actually occur. Reporting depends on busy clinicians taking the time to document problems, often in environments where they worry about blame, professional consequences, or simply never hearing back about what happened after they submitted the report. Not surprisingly, many physicians rarely use these systems at all. Even when reports are filed, another challenge emerges… what happens next. Many hospitals focus on collecting reports rather than learning from them. Without structured analysis, feedback to staff, and real action plans, the data simply accumulates without driving meaningful change. In other high-risk industries like aviation, reporting systems exist for one reason, learning. Healthcare should be no different. Event reporting should be a starting point, not the end goal. The purpose is not to generate more reports, but to identify hazards, investigate root causes, and implement changes that prevent the same harm from occurring again. If hospitals want safer systems, reporting must lead to learning, and learning must lead to action.

Healthcare provider “gaslighting” is often framed as a personality issue. It’s usually not. Doctors are working without time, without resources, and under pressure to move quickly. They’re expected to see more patients in less time, with limited support. So when someone raises concerns, the easiest response becomes: “I don’t see anything.” And doctors do care, but the system rewards speed. That’s how dismissal becomes routine.

“I don’t see anything” sounds reassuring. But it can be one of the most dangerous phrases in medicine. Because it often means the test didn’t show it, not that the problem doesn’t exist. When imaging or limited testing becomes the final answer, real symptoms get brushed aside instead of being investigated further. That gap between what’s visible and what’s real is where delays, missed diagnoses, and preventable harm begin.

Patients don’t just navigate illness. They navigate silos. If a problem doesn’t fit inside one provider’s “box,” it gets passed along or dismissed entirely. “Not my area.” “Try someone else.” So patients bounce between departments, repeating the same story, hoping someone takes ownership. Too often, no one does. That’s how people fall through the cracks in a system that was never designed to connect the dots.

Much of medicine relies on subjective complaints, pain, dizziness, confusion. But because they can’t be easily measured, they’re often treated as less credible. So when symptoms don’t align with imaging or test results, they get minimized or questioned. Because the system prefers what it can quantify and confirm. And that bias is where early warnings get missed, and real suffering is overlooked.

Patients are often labeled as exaggerating. But here’s the question: How would you know? If you’ve never experienced that exact injury, that exact pain, what are you comparing it to? Pain isn’t objective because it doesn’t show up neatly on a scan. So calling someone an exaggerator often fills the gap between uncertainty and understanding and says more about the system’s limits than the patient’s reality.

You’ll often hear large malpractice verdicts described as “nuclear” or “thermonuclear.” The label is meant to imply something irrational or out of control. But that framing ignores what those verdicts actually represent. When a patient suffers catastrophic harm, brain injury, paralysis, wrongful death, the lifetime cost of care, lost income, and human suffering can reach tens of millions of dollars. Juries hear the evidence and make that calculation. Calling those verdicts “nuclear” doesn’t change the harm that caused them.

There’s a comforting belief many people hold about healthcare: If you go to the best hospital and see the best doctor, you’ll be safe. But the reality is more complicated… Preventable medical harm happens in every type of institution, including large academic centers, community hospitals, rural facilities, and elite systems. Medicine is complex, and even high-performing organizations can have unsafe processes. Medical error doesn’t discriminate. It affects wealthy and poor patients, young and old, urban and rural. No family is immune.

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Every child who enters a hospital begins a complex journey. Hundreds of steps. Dozens of handoffs. Any one of them, a miscommunication, a missed detail, a process no one thought to question, can lead to harm. Most hospitals respond to these moments privately, investigate quietly, fix what they can, and move on. But a group of nearly 60 children's hospitals decided to do something different. They built a system where hospitals share their most uncomfortable moments, errors, near-misses, and diagnostic failures with each other. To prevent the next child from experiencing the same harm, without assigning blame. It's called the Child Health PSO, and it works. More than 2,800 safety events analyzed. Over 4,200 early warnings issued. A diagnostic toolkit now accessed in 19 countries, because a communication failure spotted in one hospital became a structured solution for thousands of care teams worldwide. When one hospital noticed that over half of children's hospitals cited communication breakdowns as a top driver of diagnostic errors, they didn't sit on it. They built a timeout template. A moment built into the care process where every voice on the team is heard before a diagnosis is confirmed. A medication error prevented, a diagnosis clarified, and a child who makes it home safely. The insight behind all of it is simple, and deeply counterintuitive for most organizations: You don't have to experience harm to learn from it. When institutions compete on reputation, they hide their mistakes. When they compete on outcomes, they share them. The hospitals in this network chose outcomes. That's what a real safety culture looks like, not the absence of failure, but a system designed so failure never happens twice.

The volume of information in modern litigation is staggering. Thousands of pages of medical records, dozens of depositions, expert reports, and research literature. For a boutique practice, keeping up used to require enormous time and resources. AI is changing that. It can sift through mountains of material, identify relevant studies, and surface contradictions in expert opinions in minutes. That doesn’t replace judgment or trial strategy. But it gives smaller firms the ability to compete with massive defense teams. And that’s a good thing for accountability.

Patients often describe the same experience: They raise concerns about worsening symptoms, and they’re told nothing is wrong. Sometimes this is framed as “reassurance.” But too often it becomes something closer to gaslighting. The uncomfortable truth is that this usually isn’t about one bad doctor. It’s about a system where clinicians are overbooked, short on time, and working inside rigid silos. When complaints don’t fit neatly into the box in front of them, the easiest response is dismissal or referral. And that’s how people fall through the cracks.

I’m often asked why I don’t talk publicly about the details of the cases I’m handling. The answer is simple: I don’t handle cases for the media, I handle them for my clients. People who have experienced catastrophic harm deserve privacy, dignity, and focus, not public commentary about their lives. There will be time later to talk about broader lessons, systemic failures, and what we can learn. But during the case, the priority is the client.

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When someone gets a serious diagnosis, we say it happened to them. But that's not quite right. It happens to their spouse, who starts sleeping lighter, listening for sounds in the night. To the child who learns to read the room before asking how dad is doing. To the sibling who becomes the coordinator, the communicator, the one who holds everyone else together. Kristin Flanary has a word for this: co-survivorship. Her husband, Dr. Will Flanary, is a physician who faced a life-threatening illness.  Together, they found their way through it, in part through humor, in part through radical honesty about what they were each carrying. Kristin's insight wasn't about minimizing her husband's experience. She focused on naming something caregivers feel but rarely say out loud: that they are surviving too. This idea sits at the heart of The Conversation Project's work. When families avoid talking about death, about what someone actually wants, what matters most to them, what they're afraid of, they don't avoid the grief. They just face it alone, and they face it twice. Once when the moment comes, and again when they wonder whether they made the right call. Honest conversation changes that. Because it removes the layers of doubt and distance that pile on top of an already unbearable experience. It gives families a shared language before they need it most. Artist Candy Chang captures something similar in her work on grief and mortality. Reflecting on death, she argues, isn't morbid, it's clarifying, and it strips life down to what's essential. When people were asked to write what they wanted to do before they died, they didn't write about medical preferences. They wrote about seeing the ocean, performing again, and watching their children fall in love. That's what end-of-life planning is really about. The people you don't want to leave behind, and making sure they know it.