Mrs. V’s grown children encouraged their father to seek the advice of a plaintiff’s attorney as to whether there might be a case for medical malpractice in the death of their mother. Mr. V met with an attorney and explained what had happened. The attorney agreed to take the case, and sued Ms. N, the cardiologist, and the medical center for medical malpractice.
Ms. N contacted her medical malpractice insurance company and met with the defense attorney who was provided for her. The attorney asked whether she was familiar with the risks or side effects of amiodarone. Ms. N confessed that she was not.
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“I’ll retain some defense medical experts to look at the patient’s files and review the claim,” the attorney said. “Then we’ll have a better idea of what we’re up against.”
In the meantime, during investigation of the case it was discovered that the patient’s cardiologist was not the one who originally prescribed the amiodarone. It was actually prescribed by the surgeon who performed the patient’s colectomy and resection. The medical center and the cardiologist were thus dismissed from the lawsuit, leaving Ms. N as the sole defendant.
The medical experts retained by Ms. N’s attorney to review the records were critical of Ms. N’s lack of knowledge about the side effects of amiodarone and of her failure to contact the cardiologist to discuss the patient’s medication. Given the expert opinions and because Ms. N was now the only defendant left in the case, the case was settled out of court for the policy limits on Ms. N’s malpractice insurance.
Legal background
Medical experts are almost always used in medical malpractice cases. Both sides (plaintiff and defendant) typically have their own medical experts who will review the medical records and advise the attorneys whether they believe the defendant acted properly or not, based on the evidence.
Experts are also used at trial to testify as to the standard of care owed by a clinician to her patient. Often, the decision of whether to attempt to settle a case is based on the input of medical experts who weigh in on whether the defendant breached the applicable standard of care.
Protecting yourself
When nurse practitioners are sued for medical malpractice, claims typically involve diagnostic errors (misdiagnosis, delayed diagnosis, failure to diagnose), treatment errors (failure to treat, improper treatment), or prescribing errors (failure to recognize contraindications, improper prescribing, improper medication management), and these errors are often the result of communication failures or documentation errors. This month’s case examines how a nurse practitioner’s attempt to be helpful to a patient in a difficult situation ended up causing harm to both the patient and the clinician.
While Ms. N was trying to be kind to a long-time patient with serious problems, her kindness backfired for both the patient and herself. A simple call to the cardiologist to confirm whether Mrs. V should still be on the medication, and at what dose, would have been an easy way to avoid the problem. It would also have been professional courtesy to let the cardiologist know that the patient was asking for a refill from the nurse practitioner.
Aside from not contacting the cardiologist (or prescribing physician), Ms. N made several other mistakes. She admittedly was unaware of the numerous side effects of the medication she was prescribing. She never evaluated, or even spoke to, the patient during the two refill incidents. She never spoke to any of the patient’s other physicians about the medication or refilling the amiodarone herself.
Protect yourself by having timely and proactive discussions with physicians and other members of the patient’s care team to ensure that everyone understands the patient’s treatment plan. Speak with a pharmacist about questions regarding unfamiliar medication side effects or interactions. And finally, do not refill a prescription from another clinician without first checking with the clinician.
Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.
