“Your right wrist, unlike your left one, will not heal on its own,” Ms M explained. “You have 2 options — casting or surgery.”
The patient responded, “I really don’t want surgery. Will the casting fix it too?”
Ms M explained to the patient that the injury would heal with either treatment, but it would take longer with casting. “I would recommend you opt for surgical treatment,” said Ms M. “The healing process will be shorter.”
“No, I don’t want surgery. I’m willing to wait longer for the recovery,” said Mrs G.
Ms M nodded and explained the casting process to Mrs G. Ms M then performed a closed reduction with anesthetic before re-splinting the patient’s right wrist. Mrs G was instructed to return in a week to have a cast placed.
Upon Mrs G’s return 1 week later, Ms M performed a second closed reduction with anesthetic before placing the wrist in a cast. Mrs G was scheduled to return regularly to have the cast checked.
During Mrs G’s 4-month follow-up appointment, Ms M became concerned that the wrist wasn’t healing properly. However, she was uncomfortable approaching Dr P, who was the supervising physician scheduled that day.
When Ms M examined Mrs G in the fifth month of treatment, Ms M knew unequivocally that the wrist wasn’t healing properly. She asked Mrs G to wait while she stepped out of the examining room to speak with one of the physicians, who told her to refer the patient to a hand specialist.
“Who were you talking to?” asked the patient.
“Oh, one of the physicians,” answered Ms M. “He thinks you should be referred to a hand specialist.”
Mrs G responded, “Wait, aren’t you a physician?”
“No, I’m a physician assistant,” said Ms M. “I told you that when I introduced myself.”
The patient grabbed the referral for the hand surgeon and left in a fury.
A few hours later, the hand surgeon called Ms M and admonished her for not referring Mrs G to a specialist sooner. The patient eventually required major surgery, specifically osteotomy with placement of a plate and 10 screws. Mrs G lost range of motion and grip strength in her wrist and hand and was no longer able to operate a computer keyboard at work. She hired a plaintiff’s attorney and filed a lawsuit against Ms M and the orthopedic practice.
Ms M met with the defense attorney provided by her insurance company. The attorney informed her that the patient was claiming that Ms M misrepresented herself as a physician and that she gave Mrs G bad advice and was negligent in her treatment.
Ms M explained to the attorney that she had indeed introduced herself as a physician assistant, and the letters “PA” were on paperwork, prescriptions, and Ms M’s jacket. “I recommended to the patient that she undergo surgical correction,” said Ms M. “It was her decision to proceed with the alternative option of casting.”
Settlement negotiations failed, and the case went to trial. The plaintiff introduced testimony from orthopedic experts, who faulted Ms M on her treatment of the patient and for failing to notify a specialist sooner when she began to suspect that the bone wasn’t healing properly. They also faulted Ms M’s employer for not executing proper oversight. In turn, the defense introduced experts to testify that casting is a valid treatment option for a wrist fracture.
After a 9-day trial, which included a day and a half of deliberations, the jury found Ms M and the practice liable and awarded more than $500,000 to the plaintiff.
Always announce your title so that it is clear to patients from which type of provider they are receiving care. After outlining all of a patient’s options, encourage them to get a second opinion if you believe they are making the wrong decision in their care. Most importantly, never hesitate to ask for advice when you believe a patient has a problem that you cannot solve. It is well worth risking irritating a supervisor to ensure that a patient is getting the proper treatment.
Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.