News: The patient, a 52-year-old man, unknowingly contracted a bacterial infection from a routine injection administered as part of the process for an MRI. He sought follow-up care related to the initial MRI procedure a few days later, and met with a physician at a hospital. A culture test was performed, and the physician had access to the test results, which revealed the bacterial infection. Despite these test results, the physician sent the patient home without any antibiotics or a definitive diagnosis after a 25-minute consultation. Two days later, the patient was rushed back to the hospital with crippling pain. The severe infection compromised the patient’s tissue and bone in his hip, which resulted in him requiring a complete hip replacement procedure three months later. The patient brought suit against the consulting physician and the hospital, and he claimed that the physician should have identified and treated the infection based on the culture results. The defendants claimed they met the applicable standard of care. The jury found both liable and awarded the patient $2.3 million in damages.

Background: The patient was a 52-year-old man who worked in construction. In 2010, the patient underwent an MRI procedure that included a routine injection as part of the process. A few days later, he visited a hospital for follow-up care relating to the MRI and met with a physician, the head of the hospital’s orthopedic surgery. The patient had a culture test performed that revealed a severe bacterial infection. However, the patient had a 25-minute consultation with the physician, who had the test results at this time but failed to diagnose the infection. The physician released the patient home without any antibiotics or any definitive diagnosis. Two days later, the patient was rushed back to the hospital with crippling pain, at which point the severe infection finally was discovered. By this point, however, the infection had spread throughout the patient’s system, and the damage already was done. The severe infection compromised the patient’s tissue and bone in his hip, and he required a complete hip replacement procedure three months after the infection. As a result of the infection, the patient was unable to resume his work in construction and suffered from limitations in his other daily activities.

The patient brought suit against the physician and the hospital, as the employer of the physician, and he alleged that the physician’s brief consultation and failure to identify and treat the infection constituted a deviation from the standard of care. The patient did not bring suit against the parties responsible for causing the infection itself, despite the fact that they set the series of events in motion. It is unclear why this choice was made, but it is possible that the patient felt the subsequent failures were more significant and a more direct cause of the hip injury. The patient’s primary allegations related to this point: The physician exacerbated an existing condition, the infection, rather than creating a medical condition. Accordingly, the patient and his experts believed that the infection could have been contained or treated sooner had the physician properly diagnosed it at that time. The defendants claimed that, given the information the physician had at the time, his course of action fell within the appropriate standard of care. The jury agreed with the patient and found the physician and hospital jointly and severally liable. The jury awarded $2.3 million in damages.

What this means to you: The primary issue for the providers in this case was whether the failure to identify and treat an existing condition constituted a departure from the standard of care. The patient here did not seek recovery against the parties responsible for initially causing the infection, but rather targeted the physician and hospital that could have prevented the serious injury that occurred as a result of the infection. Once an individual becomes a patient, a provider owes that patient a duty to provide the appropriate standard of care, and the providers take the patients as they are. Exacerbating an existing condition can constitute negligence if a reasonable physician, given the same or similar circumstances, would not do such. The physician in this case was not initially responsible for the infection, but once the patient came under his supervision, he was responsible for treating that infection in accordance with the standard of care.

Healthcare-associated infections (HAIs) are quite common. According to the Centers for Disease Control and Prevention (CDC), based on a large sample of U.S. acute care hospitals, one in 25 hospital patients has at least one HAI. The CDC has established numerous guidelines for prevention and treatment of HAIs, including specifics for injection safety such as using aseptic technique in a clean area free from contamination. Most hospital-acquired bloodstream infections occur after insertion of a central venous catheter used for long-term administration of fluids and drugs. However, bacteria can enter the bloodstream after any type of intravenous procedure. If a patient complains of symptoms following this type of procedure, an infection should be suspected. Sepsis screening should be performed and is the standard of practice in hospitals today. Blood cultures are a vital clinical tool used to diagnose septicemia suspected after an intravenous procedure. The presence of bacteria in the bloodstream is considered a “critical value,” and hospital and freestanding laboratories have protocols in place to immediately notify physicians of the test results. For more information, visit the CDC’s website at http://www.cdc.gov/hai/index.html.

Physicians and healthcare providers must recognize that HAIs are common, and when they are treating a patient who recently has received healthcare services or undergone a procedure involving an injection, extra precautions should be taken to rule out the possibility of an infection. In this case, the hospital followed the proper procedure by ordering the culture test, which did reveal the presence of an infection. However, ordering the appropriate test or tests is only the first step in the course of treatment.

Following up after receiving test results is the next step and is critically important. Merely performing diagnostic tests does nothing to help a patient recover from an illness. It enables the physician or healthcare provider to properly diagnose the patient, but then the care provider must continue by prescribing appropriate medication, recommending and performing an operation, or providing whatever the appropriate treatment is based on the diagnosis. Because it can be days before some culture results are ready, physicians should be sure to have current contact information for patients so that the patient can be notified if positive test results are received after the patient has been to the physician’s office. It is then the duty of the physician to quickly treat the patient for the infection. Any breach of this duty falls well below the standard of care and is negligent. A delay in treating a bloodstream infection can result in bacteria “seeding” around a heart valve or in a joint, with disastrous results.

Failure to treat an underlying condition can constitute medical malpractice in which there is deviation from how a reasonable physician, given the same or similar circumstances, would treat the condition. However, this analysis is dependent upon the condition and the patient. A physician cannot force a patient to receive treatment for an illness, but the physician has a duty to inform the patient of his or her options for treatment as well as the consequences of forgoing treatment. In certain situations, a patient might find the detriments of treatment to outweigh the benefits of that treatment. The patient has the knowledge to make the decision, and physicians fulfill their duty by giving the patients that knowledge. However, for a simple situation such as an infection, it is doubtful that a patient will refuse treatment given the simple nature of the treatment and minimal, if any, side effects or negative consequences of the treatment.

Reference:

  1. Supreme Court of Rockland County, NY. Case No. SU-2011-004050. June 4, 2014.