Patient Sued Multiple EPs in Two EDs: One Settled, Others Dismissed
EP wrongly assumed patient was seeking narcotics
A male patient in his 30s was seen at an emergency department (ED), where he displayed some evidence of epidural abscess, but was discharged with a diagnosis of back pain. "Plaintiffs' counsel alleged that the emergency physician [EP] never ordered even a simple CBC [complete blood count] to investigate the possibility of infection because of the ED's conclusion that the patient, a heroin addict, was just looking for narcotics," says Scott T. Heller, Esq., an attorney with Reiseman, Rosenberg, Jacobs & Heller in Morris Plains, NJ.
Two days later, the patient arrived in a different ED at 1 a.m. on a holiday, paralyzed from the waist down due to an epidural abscess. He was evaluated by the EP and sent for imaging studies.
The EP also consulted a neurosurgeon and contacted an internist, who accepted the patient on her service. "The patient alleged delay in obtaining the necessary imaging studies while he languished in the ER for almost 20 hours," says Heller.
A second EP became involved due to a change of shift in the ED. "But he felt he was only 'babysitting' the patient, who had already been admitted — even though the patient remained in the ER until he was taken to surgery later that night," says Heller. During this time, it was alleged, the patient's chance of recovery deteriorated.
All three EPs, the internist, the neurosurgeon, and both hospitals were named as defendants. It was alleged that an order by the first EP for a CBC, MRI, or CT scan would very likely have resulted in diagnosis of the epidural abscess.
"By the time of admission to the second ER, the patient had already suffered sudden onset of paralysis, most likely due to occlusion of the blood supply to the spinal cord," says Heller. The defense's neurosurgical experts explained that by the time of admission to the second ED, the patient's paralysis was permanent, and would not have been reversed even with instantaneous diagnosis and treatment.
The physician from the first ED settled with the plaintiff. His documentation suggested he quickly concluded the patient was not ill, but merely sought narcotics. "The patient alleged the absence of an order for a simple CBC suggested the first EP never considered or investigated the possibility of infectious process such as an epidural abscess," says Heller.
Lack of Clear and Timely Communication
All of the doctors involved in the second ED admission were fortunate to be dismissed, says Heller. "Plaintiffs' counsel would likely have proven that misunderstandings and lack of communication combined to create an unreasonable delay of 20 hours in obtaining the necessary imaging studies," he says.
However, since even the plaintiff's expert agreed it was unlikely that the patient would have regained neurological function, even with immediate diagnosis and surgery at the second ED, no damages could be established.
Heller says the case raised these questions: "Who was responsible for the patient?"and "Who was obligated to see that tests and results were obtained in a timely fashion?"
"A note by the EP containing the date, time, and content of communication amongst the providers would have been helpful for the EP's defense," says Heller. For example, the EP could have charted: "Neurosurgical consult informed of imaging study results and will be in to see patient."
Since the patient remained in the ED, the plaintiff attorney argued that he was still the EP's responsibility. "It was also alleged the patient 'belonged' to the internist, whose service accepted him, even though he had not yet been admitted to a hospital room," says Heller. In addition, it was alleged that the neurosurgeon who had been consulted was responsible for the patient, since the patient's presentation was neurosurgical in nature.
"There was also some conflict regarding communications amongst these three physicians and the radiologist, who ultimately interpreted the delayed imaging studies," says Heller.
To protect themselves legally, Heller recommends that EPs communicate clearly with attendings and consultants regarding:
- the EP's evaluation and recommendations;
- what is to be done for the patient;
- who is ordering tests, obtaining results, and formulating the plan of care;
- who will be providing that care.
"Document the content and time of communications regarding these items," he advises.
For more information, contact:
- Scott T. Heller, Esq., Reiseman, Rosenberg, Jacobs & Heller, Morris Plains, NJ. Phone: (973) 206-2500. E-mail: SHeller@rrjhlaw.com