After his years of medical treatment, Mr K consulted with a plaintiff’s attorney who advised Mr K to sue. “The clinic is federally funded, so we will actually be suing the United States in Federal District Court,” the attorney stated.
Although Ms D was not being individually sued, the lawsuit was based on her negligence, so she spoke to the defense attorney. After reviewing all the information, the patient’s medical records, and the reports from the medical experts, the attorney looked grim. “Honestly, I don’t think we have a great case here, but our best argument is that Mr K contributed to his own kidney disease by being noncompliant,” he said.
The case went to trial in front of a federal judge.
At trial, Mr K testified that he was never told that there was a connection between high blood pressure and kidney disease, that he was not given any patient education, and that he had not known there was a risk of kidney disease if he did not take his medication daily (even when he was feeling fine.) He thought that if he felt okay, it meant that he did not have to take his medication.
Ms D testified that she had provided patient education, but the notes in the chart included nothing other than a 2008 notation of “healthy eating habits.”
The judge believed the plaintiff’s medical experts who testified that Ms D had deviated from the standard of care in numerous ways, including the failure to: provide proper education, recommend home blood pressure monitoring, order labs or respond to lab results, and consult the collaborating physician or refer the patient to a specialist. The experts were also critical of Ms D’s decision to give Mr K clonidine in the office on multiple occasions. The judge dismissed the defense’s argument that Mr K contributed to his own medical condition. Ultimately, the court awarded more than $29 million in damages to Mr K.
Ms D allowed burnout to affect her work and to cause her to make assumptions about her patient. What care should she have given Mr K? The standard of care required:
- Patient education and consistent re-education, including: basic information about hypertension, risks of uncontrolled hypertension, the fact that Mr K had an increased risk of kidney damage from uncontrolled hypertension because he was a young African-American male, lifestyle modifications, the importance of taking medications daily, and attending follow-up appointments
- Recommendation and instruction for home blood pressure monitoring
- Ordering lab tests at least 1 to 2 times a year to monitor for organ damage
- Appropriate action in response to lab results
- Consultation with the collaborating physician if there is difficulty controlling blood pressure
- Referral to a nephrologist when she was unable to control the patient’s blood pressure.
In addition, Ms D failed to appropriately document information in the patient’s file.
Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, NY.