Negative online reviews for medical procedures can sting. But suing a disgruntled patient for defamation can add insult to injury, as a recent appeals court decision makes clear.

Under amendments to New York state’s Anti-Strategic Lawsuits Against Public Participation (anti-SLAPP) statute, losing a defamation lawsuit against a patient could result in the patient recovering attorney fees, on the grounds that candid reviews of medical providers constitute matters of public interest (and protected free speech); and that frivolous lawsuits attacking these rights entitle the patient to recover damages.

In Aristocrat Plastic Surgery v. Silva, a prominent Manhattan plastic surgeon, Dr. Kevin Tehrani, sued a patient, Paige Silva, for posting scathing reviews of her experience on RealSelf.com and Yelp.com. Dr. Tehrani filed suit against the “knowingly and materially false” reviews that would “defame and irreparably harm Plaintifs.” The doctor lost the suit, but the patient was denied recovery of attorney fees and damages. When she appealed, the Appellate Division, First Department deemed the lawsuit had burdened the defendant with costs and threat of litigation after she engaged in protected speech. Under anti-SLAPP statutes, it added, she was entitled to attorney fees and damages.

What’s the takeaway for New York state health care providers? If you sue someone for defamation, no matter now tempting, think twice before proceeding. If you lose, the defendant may go after your institution for attorneys’ fees.