Mr. D, an office-based physician assistant, worked alone every other Saturday. He and the family practitioner, Dr. M, offered office hours six days a week. The clinicians alternated Saturdays, believing it was important to stay open for patients with emergencies or the need for special hours.

Saturdays could be busy, and without having another clinician as backup, Mr. D felt pressure to hurry though his exams. Normally, he liked to chat with patients—but not on Saturdays.

On this particular Saturday, he treated Mr. F, a patient who had been in the week before. Since there were many other patients waiting, Mr. D quickly thumbed through the patient’s file. On his most recent visit, Mr. F had complained of diarrhea that had lasted for about four days.

“Are you still having the same problem?” asked Mr. D.

“Yes,” said Mr. F. “I took your advice and ate rice and a bland diet, and it got a bit better for a day or two. But then it started again.”

The patient told Mr. D that this episode had lasted three or four days. Mr. D asked Mr. F if anyone else in the household was ill. The answer was no. He asked the patient if he had traveled out of the country recently. This answer was also negative. Mr. F was otherwise in good health, had no underlying chronic illness, maintained an appropriate BMI, and reported exercising and eating a relatively healthy diet.

“Diarrhea is a very common problem,” said Mr. D. “There are a variety of causes, but in most cases, it will just go away.” He then advised the patient to drink Pedialyte or Gatorade and call back if the condition did not resolve.

One week later, Mr. F called to report that he still was suffering from diarrhea and wanted to schedule a follow-up appointment. Unfortunately, he was about to go on a week-long vacation with his family.

“Can I schedule the appointment for next week, after I get back?”

“Sure,” said Mr. D. “Hopefully by then you’ll be feeling fine. Have a great trip!”

Mr. F never made it back to the office. He spent a week at the beach with his wife and two sons, but when they returned home, he told his family that he didn’t feel well and was going to lie down in his den. His wife went to bed. His sons found Mr. F dead on the couch the following morning.

Several months later, when Mr. F’s widow got over the shock of losing her husband, she decided to consult with a plaintiff’s attorney.

“My husband had diarrhea for a month before he died. He went to the doctor twice. All they told him to do was to drink Gatorade and eat a bland diet!”

The attorney contacted a consulting physician who suggested that Mr. D had been negligent in not taking a stool culture and blood test and failing to monitor for dehydration. “The cause of death was an electrolyte imbalance,” the consulting physician reported. “This should have been prevented. It should not have been shrugged off so easily.”

The attorney filed a lawsuit against Mr. D alleging that his negligent treatment was the cause of Mr. F’s death.

When learned about the lawsuit, Mr. D immediately called the defense attorney provided by his insurance company. Depositions and discovery took place over the next few months. It became clear that Mrs. F’s attorney was going to argue that Mr. D was responsible because he did not attempt to discover the underlying cause of the diarrhea or properly monitor the patient for dehydration. The plaintiff also alleged that advising the patient to drink Pedialyte was improper, as it is made for infants and children and would be inadequate to replenish electrolytes in adults. Mr. D’s attorney planned to argue that since the patient felt well enough to go on vacation, the situation was not that serious at the time that he was treated by Mr. D.

The case never went to trial and was eventually settled for $1,875,000.

Legal background

Coming to a monetary amount for what a life is worth is not easy, and the process can be confounding. For example, the untimely death of a child, which seems most tragic, does not necessarily equate to a high settlement or jury verdict. Even though the child had an entire life yet to lead, “value” is often based on earning potential, and no one knows what the earning potential of that child would have been. Similarly, compensation amounts for the loss of an elderly retired person are also usually lower.

Mr. F garnered a substantial salary as the vice president of a large corporation and was in his prime earning years. He also was supporting, emotionally and financially, a wife and two children. These factors, as well as the defendant’s insurance limits, are all taken into account when trying to decide on a settlement amount.

Protecting yourself

According to the National Digestive Diseases Information Clearinghouse, the average adult has a bout of acute diarrhea four times a year. Normally, however, this situation will last one or two days and resolve on its own. Diarrhea lasting more than two or three days can lead to dehydration and may be a sign of something more serious. Mr. D properly asked Mr. F whether anyone else in the home was sick (to ascertain whether it was a viral infection) and whether he had traveled out of the country (to determine whether it might be caused by bacteria or parasites). However, Mr. D should have taken it a step further and tried to actually determine the cause of the condition via a stool or blood sample. When the patient called back (after two previous office visits for the same complaint) to say that he still was suffering from diarrhea, Mr. D should have asked him to come to the office immediately. He certainly should have asked Mr. F whether he was having any symptoms of dehydration (e.g., dry mouth, less frequent urination, dark-colored urine) and should have advised him very clearly about the dangers of becoming dehydrated. Even common conditions can be threatening if they persist. If a patient has symptoms that don’t abate in a normal span of time, a second look is in order.

Ms. Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.