Legal Review and Commentary: Communication failure yields settlement
Legal Review and Commentary
Communication failure yields settlement
News: A man underwent a series of tests after experiencing shortness of breath and pain in his chest. While the cardiologist reviewed the results of the tests, the man again began to experience shortness of breath and weakness in his legs. Although the technician attending to the man instructed the patient to wait in the waiting room until the doctor finished with another patient, the man left the waiting room and suffered a heart attack on the way home. The parties settled the case for $1.2 million.
Background: A 54-year-old man visited his family practitioner complaining of shortness of breath and pain in his chest. The doctor referred the patient for evaluation to a cardiologist, who scheduled a stress test with echocardiogram to evaluate the patient's cardiac condition. During the echocardiogram, which provided the doctor with an image of the patient's heart's internal structures, size, and movement, the man did not complain of any symptoms or pain. The results of the test were normal.
The doctor then instructed the man to walk on a treadmill, gradually increasing the speed and incline, while the cardiologist looked for changes in the echocardiogram pattern and in the man's symptoms. The treadmill then was stopped, and the patient was instructed to lie down immediately on a bed to allow the doctor to perform a second echocardiogram to visualize his heart's motion with exercise. The results of the echocardiogram appeared to be normal at first, but the doctor then noted that during the last few minutes of the second echocardiogram, the waves used to detect the heart's electrical voltage demonstrated significant abnormalities. Nevertheless, the doctor did not respond to them. He instead took the results of the test to his office to review, after which he dictated a report indicating that the EKG was entirely normal.
While the doctor was reviewing the test results in his office, the patient complained to the technician that he was experiencing shortness of breath and weakness in his legs. The technician escorted the man from the stress test suite to the waiting room so that she could inform the cardiologist of the man's complaints. After the technician told the doctor of the man's condition, the cardiologist told the technician that he would examine the patient in the waiting room, but not until he finished a scheduled stress test for another patient. While waiting for the cardiologist in the waiting room, the patient began to feel better and decided to leave on his own accord. While driving home, he suffered a massive myocardial infarction and died.
The man's estate sued the cardiologist for negligence. The estate claimed that the abnormal test results should have been detected while the man was still in the stress test suite and that the doctor should have begun to treat the man's condition immediately.
Although the defendants countered that the patient was comparatively negligent, having left the waiting room on his own accord, the plaintiff argued that the man never should have been taken out of the stress test suite in the first place. The parties settled the case for $1.2 million before trial.
What this means to you: This scenario raises concerns from all three of the parties involved in the patient's care and treatment. First, it may be that the family practitioner should have referred the 54-year-old man to an emergency department (ED), rather than to a cardiologist. "Without knowing the time frame, it is difficult to judge whether this is a real issue. However, if the family practitioner had strong concerns, it would appear that referral to an ED would have been more appropriate," suggests Ellen L. Barton, JD, CPCU, a risk management consultant in Phoenix, MD.
Upon referral from the family practitioner, Barton notes that the cardiologist should have given this case a higher level of scrutiny. Although this scenario occurred in a physician's office setting, it raises concerns of similar risks occurring in a hospital's ED. For example, if a patient is receiving continuing evaluation, it is not appropriate to have him or her return to the waiting room while the test results are interpreted. By not communicating any problems to the patient, the cardiologist was giving the impression that nothing was wrong. Communication always is important in health care, and here the lack of communication caused an unfortunate result. Second, when the cardiologist recognized "abnormalities" with the patient's echocardiogram results, knowing that the man had been referred by a family practitioner, the cardiologist should have been alerted to something more serious and acted accordingly. Indeed, Barton notes that there may well have been a "failure to diagnose," which only additional training can help to resolve.
Unfortunately for this patient, even when the cardiologist finished the testing, the treatment he received did not improve. "When the patient complained to the technician of shortness of breath and weakness in his legs, there was yet a final opportunity to do the right thing. The technician should have alerted the physician immediately and told the patient to stay put," says Barton. Nursing staffs and ED personnel also should be mindful of this advice, as ignoring acute symptoms is destined to be a recipe for disaster. And when the cardiologist was informed that the patient was exhibiting acute symptoms, he should have interrupted the other test he was performing to attend to the first patient. "There was clearly an overall failure to read and correctly interpret the information presented," says Barton.
To remedy the problems highlighted by this scenario, Barton recommends that when patients are referred from other physicians, contact should be made with the referring physician to get as much information as possible. And whenever a patient is being treated by a health care practitioner, whether in an office or facility setting, the staff should be instructed to interrupt physicians immediately when patients are demonstrating acute symptoms. Patients experiencing acute symptoms should not be moved out of a treatment room, and they especially should not be moved to the waiting room. And finally, physicians must attend promptly to patients in their offices who are demonstrating acute symptoms. Given the deviation from these suggestions by the cardiologist and the technician in this case, the $1.2 million settlement is not surprising. Nevertheless, Barton recognizes that implementing just these few procedural changes can reduce liability claims and increase patient satisfaction.
- Cuyahoga County (OH) Common Pleas Court, Anonymous Case No. [Stephen S. Crandall and James M. Kelley III, Elk & Elk (Mayfield Heights, OH) for the plaintiff].
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