News: The patient, a 47-year-old woman, was admitted to a hospital's emergency department, complaining of severe back and abdominal pain. The physician diagnosed her with back spasms and sent her to an observation ward for monitoring and treatment without ordering additional tests or consulting any other physician. The patient died the following day as a result of a bowel obstruction, which the physician failed to diagnose. The patient's family filed suit against the physician and his employer group, and the family claimed that the physician's failure to diagnose fell below the standard of care. The defendants denied liability. The jury awarded $2.4 million in damages against the physician and his group.
Background: In this matter, the patient sought treatment at a hospital for severe back and abdominal pain. The attending physician initially diagnosed the patient as having back spasms. He did not conduct additional testing. Experts during the trial stated that the physician could have taken multiple courses of action to properly diagnose and treat the patient, such as: performing a thorough physical examination to rule out parts of his original differential; consulting a physician colleague in the emergency department; obtaining a surgical consultation; ordering serial blood work, a contrast CT scan, or repeat imaging. This physician did order a non-contrast CT scan, which he read as essentially normal. This fact, too, was debated and disproven during trial. The defense's own expert stated that the non-contrast CT was misread, and if it had been read properly, that might have informed the physician that there was more to this patient's condition.
Two years before these events, the patient underwent gastric bypass surgery. Known complications of that surgery are bowel obstruction and internal hernia. The physician here knew that the patient underwent the surgery, as it was listed in the patient's chart three times, and at least one entry was in the physician's own handwriting. However, he did not initially consider bowel obstruction to be the proper diagnosis. The patient's condition was marked by extreme pain, which was characterized as "horrible, writhing, and tearful." The physician sent the patient to an observation ward with plenty of analgesics, but this masking the pain was an insufficient substitute for treatment. The patient's condition worsened quickly, and within 10 hours from the original diagnosis of back spasms, she died as the result of a bowel obstruction.
The patient's family claimed medical malpractice and alleged that the physician failed to correctly diagnose the condition and adequately treat the patient. As discussed above, experts during trial listed numerous possibilities which the physician could and should have taken to successfully diagnose the patient. The defendant physician testified during trial that he did not know what was going on with the patient, yet his primary defense was that his non-contrast CT scan, which was improperly read, was sufficient. He additionally claimed that he performed a thorough physical examination by listening for bowel sounds and took a thorough medical history, but the record in court did not support this claim. After deliberating for two hours, the jurors came back with a verdict for the plaintiffs and awarded them $2.4 million in damages.
What this means to you: The primary issue in this case, whether the physician was negligent for failing to correctly diagnose the bowel obstruction, is relatively straightforward. When a patient presents with symptoms and has a specific medical background that might give rise to increased risk of complications, these symptoms must be thoroughly investigated. Simply transferring a patient for observation and masking the symptoms with analgesics is not a proper treatment. Such steps might give rise to liability when the underlying condition continues and results in harm. During trial, the physician admitted that he did not know what was going on with the patient. His lack of knowledge alone did not subject him to liability, but rather his failure to act appropriately given the situation, and his lack of knowledge, did.
Physicians are not omniscient, and this is no excuse for medical malpractice. When encountering an unknown condition or ailment, physicians must take certain steps to ensure the well-being of their patients. The experts in the case here listed multiple actions that the physician could have taken to seek answers to his patient's unknown illness, such as obtaining a consultation from another physician or surgeon or performing additional tests to supplement knowledge and make a better diagnosis. Thesesteps are particularly important when the patient has a known history that might indicate a potentially life-threatening condition, as the bowel obstruction evidently was. Action must be taken. If the physician himself is unclear of the correct action to be taken, then more experienced physicians with specific expertise in the relevant area should be promptly consulted.Administering painkillers and waiting to see what happens is doubtfully the best solution to an unknown question, because this mere bandage is not a true remedy.
That said, unless a patient presents with a head injury, analgesics are important to provide quickly to patients in extreme pain. Pain in and of itself might mask other symptoms and should be relieved as quickly as possible. Had the physician re-evaluated the patient once her pain was controlled, he might have been alerted to her more subtle symptoms of abdominal pain. While bowel pain can refer to the back, as it did in this case, back pain usually does not refer to the abdomen. A bowel obstruction is a life-threatening medical emergency and requires immediate surgical consultation and intervention. Even if the patient had no complaints of abdominal pain, back pain that is so severe as to cause such an extreme reaction from the patient needs further exploration. With no history of back injury and a positive history of abdominal surgery, the physician's conclusions should have warranted additional testing and surgical consultation. His failure to do this step meant that he failed to provide the standard of care, thus committing malpractice.
Relatedly, documentation is not only critical but is actually mandated for proper medical diagnosis and treatment, as well as for assisting in potential future litigation related to such diagnosis and treatment. Keeping accurate records of exactly what types of tests are conducted might be essential to prove what actually happened and in this case, those actions did not fall within the proper standard of care required. Here, the physician's testimony stated that he performed a thorough physical examination and took a thorough medical history, but the objective record that was presented to the court and the jury differed. If the physician actually did perform such a thorough assessment, he should have noted this information somewhere in the patient's file. Documentation of that assessment could have been useful for providing a credible record to the court instead of having the jury rely solely on his word that he performed such actions. Many jurors might be skeptical of the defendant's own testimony when it is the only evidence supporting his point, and rightfully so, as the defendant has a strong interest to protect himself and avoid liability. Keeping the type of records required by the medical staff of the hospital is helpful for litigation and medical purposes.
- Williamson County, IL. Case No. 2009L36. Dec. 4, 2013.