News: In 2004, a female Boston Marathon runner became dizzy after completing the race. The dizziness became so severe that the woman went to the hospital seeking treatment. The hospital administered an MRI and CAT scan, which revealed brain abnormalities in the patient. These brain abnormalities required her treating physician to put her condition into a central database to which her future physicians could have access. However, the physician who discovered the abnormality never put the information into the database.

Five years later, when the woman was pregnant, her obstetrician was not aware of the condition and recommended a natural birth. It is also worth noting that the patient never informed her obstetrician of the brain condition. Hours after the delivery of her baby, the patient had a massive stroke. The stroke left her completely paralyzed except for limited mobility of her right arm. The patient sued the first physician and the hospital where she worked for failing to enter her condition into the central database, which allegedly would have alerted her obstetrician of the condition and caused the obstetrician to order a cesarean birth that would have prevented the stroke. The defendants argued that the plaintiff should have informed her obstetrician of the condition. The jury agreed with the plaintiff and ordered the hospital to pay $35.4 million in damages.

Background: Upon completion of the Boston Marathon in 2004, a female 25-year-old Pilates instructor became very dizzy. That same day, when the condition worsened, she went to the hospital. After explaining her symptoms of extreme dizziness brought on by the Marathon, the patient was given an MRI and CAT scan. These tests revealed that she suffered from a brain abnormality that is brought on by extreme stress, and she was released that same day. The patient later alleged that upon being released, she was made not made aware that high-stress activities, such as childbirth, could exacerbate her condition and cause complications.

The hospital where the patient initially was treated has a policy that requires the physicians to enter this type of information into a “Problem List,” which is a version of the ever-developing electronic health records (EHRs). These EHRs are increasing in popularity and use, and the federal government and other institutions are working to develop national standards. Nevertheless, hospitals that sign on to use EHRs agree to input critical information such as a brain abnormality into the system. The EHRs then are viewed by other physicians to, among other things, help determine the best course of action for their patients. Unfortunately for the plaintiff, her information regarding the brain abnormality was neither added to the Problem List nor adequately documented in her medical records.

Four years later, at the age of 29, the woman became pregnant. Her obstetrician was never told about any brain abnormalities and searched the Problem List for his new patient. Having not seen her on the Problem List and with no other reason not to do so, the obstetrician recommended a natural childbirth. The obstetrician later contended that he would have ordered a cesarean if he was aware of the brain abnormality. Soon after the natural childbirth, the patient suffered a massive stroke. In addition to the stroke completely paralyzing her, with the exception of her right arm, the stroke required the patient to be in a medically induced coma for two months. An additional 16 months of hospitalization followed. Since that time, she has needed around-the-clock care and has lost the ability to communicate clearly.

The patient and her family sued the doctor and the hospital where she worked for failing to place her on the Problem List. They claimed that this failure put her at undue risk and eventually led to her life-altering stroke. The hospital, while sympathetic toward the plaintiff, argued that she should have informed the obstetrician of the condition.

The jury agreed that the physician and hospital not putting the plaintiff’s brain abnormality on the Problem List was negligent and an undue risk. Furthermore, the fact that the plaintiff didn’t appear on the list led to the obstetrician ordering a natural birth, which induced the extra stress that ultimately caused the patient’s stroke and ensuing injuries. As such, the jury awarded the plaintiff and her family, which consists of herself, her husband, and their healthy daughter, $35.4 million in damages. The hospital, having failed to enforce its own policy and employing the physician, is responsible for the damages.

What this means to you: This case is revealing as to where the future of medical practice is headed and the high cost of not staying current with the changing field. In an ever-growing manner, the practice of medicine will further involve EHRs and similar databases that allow physicians to quickly access a patient’s information.

While this news is excellent in terms of providing better healthcare, it could also be a source to which attorneys point when looking to impose legal liability onto a physician or hospital. The reason is that the fact of whether or not a patient’s information is on any particular list is a clear and easily provable fact, and it almost certainly will be negligent not to add said patient’s information into the EHRs when the hospital has agreed to do so.

With respect to EHRs, a successful plaintiff’s attorney has suggested that something as minute as leaving one of the patient’s allergies off of a database can lead to the patient’s death or serious injury and a sizable legal penalty for the hospital that employs the physician who has fallen behind the times.

Given the trend of EHRs, adherence to these evolving standards and being sure to input the patient’s information into the relevant EHRs is a must. Hospitals and physicians should be familiar with and embrace this digital change. Following the guidelines of the EHRs will result in providing existing and new patients better care as well as a means to protect the physician and hospital from costly medical malpractice litigation. As was specifically seen in this case, failing to adhere to the guidelines of the Problem List and input the brain abnormality into the database seven years prior — a task that would have presumably taken minutes — ended up leaving a patient paralyzed and costing the hospital more than $35 million in legal costs (and more than $40 million with interest). In any cost/benefit analysis, whether it be from a legal or medical practitioner, it is clear that adherence and enthusiasm toward the inevitable digital changes is the only path forward.

This case also shows the need for physicians to ensure they have elicited enough of their patients’ relevant medical history to make an informed decision. While it is true that databases with this information are becoming more prevalent and that the obstetrician who was unaware of the plaintiff’s brain abnormality did not face legal liability, a physician cannot solely rely on these databases or a cursory statement by the patient. A physician’s failure to learn everything relevant about the plaintiff’s medical history in this case led to a massive stroke and major health issues that the patient must endure for the remainder of her life.

Additionally, some in the legal community have suggested that the plaintiff or her obstetrician might be, at least partially, at fault for not having communicated about this issue themselves. As such, taking the time to explain the need for a complete medical history to the patient and ensuring the physician is aware of all relevant information can greatly benefit the patient and shield the physician and hospital from legal liability.

REFERENCE

  • Norfolk County Superior Court, Mass. Case No. 14-1223 (May 7, 2015).