By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Health Care Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Rebeka Rioth, 2017 JD Candidate
Pepperdine University School of Law
News: On June 8, 2012, a 33-year-old woman drove to the hospital and was complaining of severe head pain and other symptoms. She told doctors that she had a history of brain swelling that was caused by a pre-existing condition known as lupus and was being monitored by a neurologist. The hospital diagnosed the woman with a migraine, administered a “migraine cocktail,” and then discharged her without providing a neurological consult, performing diagnostic imaging of her brain, or reviewing her past medical history. The next day, the woman died.
The woman’s estate and her husband sued the hospital, the medical corporation that employed the hospital’s ED physicians, as well as the attending physician responsible for the woman’s treatment. The plaintiffs’ attorneys argued that the defendants did not meet the appropriate standard of medical care and treatment by failing to review the woman’s medical history, order diagnostic testing, or perform a neurological consult. The plaintiffs’ attorneys also said that the defendants failed to consider a neurological disorder or recognize and treat symptoms of a serious neurological illness, despite the fact that the woman had history of brain swelling. The jury agreed that the standard of care had been breached and awarded the plaintiffs $4.58 million.
Background: In 2010, a woman required emergency hospitalization and treatment for chronic headaches, in addition to nausea and vomiting. After a neurologist and rheumatologist examined the woman, the hospital ordered a CT scan and MRI of the woman’s brain. The imaging tests revealed cerebral edema, or brain swelling, caused by excessive fluids in the brain. As a teenager, the woman had been diagnosed with lupus, which can cause brain swelling.
The hospital administered medication that would reduce the woman’s brain swelling by draining excess fluids from her brain. Four days later, the woman’s headaches and nausea subsided, and she was discharged from the hospital.
In 2011, the woman once again experienced a chronic headache caused by her lupus and returned to the hospital for treatment. The hospital again determined that the woman had brain swelling and administered steroids intravenously to reduce the swelling. When the swelling resolved, the woman was discharged and returned to her normal life.
On June 8, 2012, the woman awoke at 3 a.m. to the sudden onset of a severe headache. The woman and her husband arrived at the hospital, where the woman complained of severe head pain, nausea, vomiting, and excessive sweating. The woman informed the doctors that the onset of her head pain had been sudden and that her pain was a 10 on a scale of 1 to 10. She also communicated to doctors that her lupus previously had caused her to experience brain swelling that now was being monitored by her neurologist.
After the woman was admitted, the hospital diagnosed her with a migraine headache and administered a migraine cocktail that included Dilaudid, Zofran, and Toradol. After the medication was administered, the woman indicated that her head pain had decreased to a 7 on a scale of 1 to 10.
The hospital then discharged the woman without providing her with a neurological consult, performing diagnostic imaging of her brain, or administering medications that reduce brain swelling. More importantly, the hospital failed to review the woman’s past medical history that detailed how she had been treated successfully for brain swelling within the past two years.
On June 9, 2012, the woman experienced the same chronic headache upon waking and soon became unresponsive when her husband tried unsuccessfully to rouse her. The woman was transported by ambulance to the hospital, where doctors determined that she could not sustain significant neurological function. She was pronounced brain dead due to herniation caused by untreated brain swelling. After life-sustaining measures were removed, the woman died shortly thereafter.
The woman’s estate and her husband sued the hospital, the medical corporation that employed the hospital’s ED physicians, and the attending physician responsible for the woman’s treatment. The plaintiffs’ attorneys argued that if the doctors had reviewed the woman’s medical history, it would have revealed that she had been treated successfully for brain swelling in the past and that her symptoms on June 8, 2012, were indicative of similar neurological swelling.
Attorneys for the hospital argued that doctors believed that the woman’s headache was a normal continuum of the patient’s chronic condition, which were her headaches.
The jury found that the hospital and treating physicians breached their duty to provide appropriate standards of medical care and treatment for the woman and awarded the plaintiffs $4.58 million.
What this means for you: This case illustrates the importance of a healthcare provider’s role in making the ultimate decisions regarding a patient’s medical care and treatment. It is standard practice for physicians to review a patient’s chart, perform a history and physical examination of the patient, and then draw assessments about the patient’s condition from this information. This information then is validated using the appropriate diagnostic testing.
It is equally common for physicians to consult the patient and/or the patient’s family about the patient’s symptoms and past medical history to obtain a more comprehensive picture of the patient’s condition. However, in doing so, healthcare providers must bear in mind that simply because a patient and his or her family are knowledgeable about the patient’s condition does not mean that they are responsible for making decisions regarding medical treatment and care, are sufficiently knowledgeable to provide qualified medical opinions, or even know what additional information they need to volunteer. These issues are the sole responsibility of the physician.
In this case, one of the ED physicians who treated the woman brazenly testified that the woman knew herself and her condition well enough that if she had wanted a CT scan, then the hospital would have considered ordering one. The jury rightly rejected this line of argument. It is not the patient’s responsibility to request standard diagnostic tests.
In addition, when gathering a patient’s medical history from a patient or a family member, healthcare practitioners must be mindful of the fact that these individuals may inadvertently provide incorrect medical information. For example, in this case, the woman’s husband informed doctors that the woman experienced “migraines” frequently. Although the woman had never been diagnosed with migraines, the husband mistakenly used this term to describe the woman’s past and present medical condition. This description, in turn, led to assumptions by the physician that resulted in the physician choosing to administer a “migraine cocktail” without first examining other possible sources for the woman’s head pain.What may seem to be the simplest or most obvious diagnoses and treatment must be confirmed diagnostically, each and every time. Consulting with specialists, a neurologist in this case, also meets the standard of care and might have saved the woman’s life.
While it is important to ascertain from the patient the reason why he or she has come to the hospital, healthcare practitioners must refrain from basing their decisions regarding patient treatment and care on this information alone. Healthcare providers are responsible for determining what is in the best interest of the patient because they alone possess the requisite level of training and skill and ultimately will be held to such a standard of care in a medical malpractice lawsuit.
Here, the woman’s doctors testified that because the woman stated that she was at the hospital for pain relief and seemed comfortable with being treated, medicated, and then reassessed for head pain, the doctors did not consider ordering diagnostic imaging such as a CT scan or an MRI. The jury determined that the hospital breached the appropriate standards of medical care and treatment required under the circumstances by failing to obtain the woman’s past medical records from the very same hospital or talk to any of the doctors who had treated her in the past.
- Summit County Court of Common Pleas, Ohio, Case No. CV-2013-11-5404 (May 19, 2016).