Measles outbreaks have alarmed public health officials in many states. Many infected people end up in ED waiting rooms. If providers miss the measles diagnosis, there are potential liability risks for both ED providers and hospitals.
“The implications of a measles case can be pretty severe,” warns Stephen Y. Liang, MD, MPHS, an assistant professor of medicine in the divisions of infectious diseases and emergency medicine at the Washington University School of Medicine in St. Louis. Serious complications such as pneumonia or brain infections can occur. If an ED patient is misdiagnosed with an upper respiratory infection and discharged, that patient could sue for failure to diagnose. Liang is unaware of any recent lawsuits involving failure to diagnose measles.
“But I do think there are potential legal risks if the emergency physician evaluated the patient and it was clearly missed,” Liang notes. There are obvious public health implications if measles, a highly contagious disease, is missed. Undetected in the ED, a measles patient can go on to expose others in the waiting room and the hospital (and, if discharged, the community). According to Liang, plaintiffs may allege the following if measles is misdiagnosed:
• The hospital was notified of cases in the community; therefore, the ED providers should have had a higher index of suspicion for measles. For some EDs, the 2014 missed Ebola case in a Dallas ED was a wake-up call to fine-tune infection control procedures.
“Measles should be in the purview of emergency physicians. It’s been in the news over and over again with several large outbreaks,” Liang says.
• EDs had not instituted any procedures for identifying and isolating patients with strong suspicion for a highly contagious disease such as measles.
• ED providers failed to notify the local jurisdiction of measles cases. “It should be simple and easy. It should not be something that needs multiple phone calls,” Liang says.
• ED providers failed to isolate the patient properly. “If someone was exposed to a contagious disease in a hospital setting because a person wasn’t isolated according to best practice infection control measures, I think people have a case for that, just as we see lawsuits for other types of hospital-acquired infections,” Liang says.
It is important to note that many EPs have not seen measles in their careers, notes Amesh Adalja, MD, an infectious disease and emergency medicine specialist and senior scholar at the Johns Hopkins Center for Health Security.
“We don’t have recent memory of it, to fear it like we used to. We almost forget that measles was a major infectious disease threat several decades ago before we had a good vaccine,” Adalja explains.
Ideally, Adalja says, EPs and ED nurses should receive updates on all ongoing outbreaks of measles, not just in the immediate area but around the country. “Having situational awareness of measles outbreaks would enhance patient safety and, consequently, reduce liability,” Adalja says.
If ED providers fail to recognize measles, they also will fail to isolate the patient. This means that others may be exposed.
To what extent, says Adalja, “will depend on whether the patient is symptomatic in the waiting room and how many people in the waiting room are unvaccinated.”
Improved identification by ED nurses and triage nurses becomes “very important,” Adalja adds. “Often, they are the first people to physically see the patient.”