Multiple recent malpractice claims alleged failure to communicate among the providers in the ED, failure to carry out the EP’s orders, or a combination of the two, reports Heather A. Tereshko, JD, principal at Post & Schell in Philadelphia. Here are common fact patterns from recent malpractice cases:
- Failure to follow the ED attending physician’s orders to place a patient on telemetry monitoring when the EP suspected myocardial infarction.
In one malpractice case, the EP ordered the patient to be admitted with telemetry monitoring. The patient was admitted to the floor, but the plaintiff attorney alleged no one carried out telemetry monitoring. “The patient was reportedly found unresponsive approximately seven hours after being admitted, and, unfortunately, could not be resuscitated,” Tereshko says.
- Improper communication in the ED when a patient presenting with chest pain underwent ECG testing.
In this case, the ECG was read as ruling out ST-segment elevation myocardial infarction (STEMI). The patient experienced chest pain again while in the ED. The physician assistant (PA) who was working in the ED requested that another ECG be performed. The PA specifically requested someone tell the ED attending interpreting the test result that it was the same patient who had undergone a previous ECG. No one ever communicated that information, and the second ECG was again interpreted to not reveal a STEMI.
The plaintiff attorney alleged that had the EP been made aware it was the same patient, the EP likely would have compared the later ECG to the earlier ECG, resulting in a different interpretation. “The allegation is that the second ECG was interpreted incorrectly, resulting in the patient being discharged and dying from an acute MI hours after discharge,” Tereshko reports.
- Failure to follow the outgoing ED attending’s order when a patient was evaluated during a shift change.
The plaintiff reported severe headache, left arm pain, and numbness, with a history of hypertension and obesity. Stroke was on the initial EP’s differential diagnosis. The EP ordered a head CT without contrast and a neurology consult.
The EP’s shift ended, and the outgoing EP signed out the patient to the oncoming EP, with the patient given pain medication in the interim. The patient reported a remote history of migraine headache in childhood. “Therefore, the discharge diagnosis was migraine headache, based on the ED attending’s rationale that a stroke would not have responded to pain medication,” Tereshko says.
The head CT was interpreted as showing no evidence of a bleed. The patient reported the headache was much better during an evaluation by the oncoming EP, who discharged the patient without waiting for the neurology consult that had been requested. “Unfortunately, the patient suffered a more severe stroke and experienced disabling injuries, which are permanent,” Tereshko says.
The patient sued the EP, alleging the bad outcome could have been prevented if the stroke had been diagnosed sooner, and that the initial ED presentation was possibly a transient ischemic attack. The case proceeded to trial and was settled before jury selection.
All these ED malpractice cases featured a similar fact pattern. In every case, the initial EP recognized the significance of a finding, but somehow it was not communicated to the next EP. “Had the initial ED physicians’ suspicions of the underlying cause of the patient’s symptoms been managed in the way that the initial ED physician planned, the outcome may have been different,” Tereshko observes.
Taken as a whole, the ED malpractice cases show that cutting corners with poor communication, says Tereshko, “can have a devastating result for the patient.”