Mr P and his wife rushed to the emergency department, but shortly after arriving there the patient underwent cardiac arrest. Resuscitation efforts were unsuccessful, and the patient was declared dead. An autopsy revealed a pulmonary embolism.
Mr N was shocked when he heard about Mr P’s passing. He had not believed that the patient’s situation had been that urgent. He felt terrible about the patient’s death, and that feeling was only compounded when he received notice that both he and the practice he worked for were being sued for medical malpractice by the patient’s widow.
Mr N met with the defense attorney provided by his malpractice insurance. The attorney had the patient’s records reviewed by his own medical experts. After the experts expressed some criticism about how Mr N handled the case, the attorney advised settling, but a settlement could not be worked out and the case proceeded to trial.
At trial, the patient’s widow introduced medical experts who testified about the standard of care in the case. The experts stated that Mr N should have ruled out the potential DVT by ordering the ultrasound as soon as the patient first complained of swelling in his calf. “An earlier diagnosis would likely have resulted in a better outcome for the patient,” testified one of the experts. “There was no reason for Mr N to have even delayed a day.”
The plaintiff’s experts were also critical of Mr N’s supervising physician, saying that she failed to provide adequate oversight of his work.
The defense introduced an expert who said that Mr N’s actions were within the standard of care, but on cross-examination, the expert stated that the best practice in this case would have been to immediately send the patient for an ultrasound.
The jury deliberated and returned with a $2 million verdict for the patient.
Although Mr N clearly knew what the signs of DVT are because he did consider it when the patient returned complaining of calf swelling, he did not act on it. He noted that it was a possibility, but doubted it was the correct one. This was his first missed opportunity. He should have sent the patient for an ultrasound immediately, understanding that DVT can be fatal and that it should be decisively ruled out right away.
His second missed opportunity was failing to explain to the patient what a DVT is, and what symptoms to look for so that the patient could go straight to the emergency department if necessary.
His third missed opportunity was when his office was notified that the patient had a DVT and instead of directing him immediately to the emergency room, he had him come to the office for an evaluation. Once he was aware that the patient had a DVT, it was now an emergency and the patient should have been directed to the emergency department immediately.
Mr N had been concerned about exacerbating the patient’s anxiety over his health by providing information which could seem frightening, but by doing so, he did his patient a great disservice.
Before jumping to any other diagnosis, be sure to eliminate the possibility of an emergency condition, such as this one. Err on the side of caution, and treat patients like adults by explaining symptoms about which they need to be aware.
Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.