Ms. C was a 37-year-old nurse practitioner working in an urgent-care clinic. The clinic was staffed by 2 physicians and 3 nurse practitioners, as well as office staff and several assistants. At any given time, there were at least 2 clinicians in the office — a physician and a nurse practitioner — and each saw a share of the patients. 


The clinic was spacious, clean, and modern and was equipped to provide laboratory testing, electrocardiograms, and x-rays. In the summer, the clinic tended to get patients with ailments such as sports injuries, broken bones, and allergies.

In colder weather, patients often came in with cold, cough, and flu complaints. On occasion, the clinic would get a patient who had a true emergency and needed immediate attention at the hospital. In those cases, the physician or nurse practitioner would refer the patient immediately to the local hospital’s emergency department. 


On a particularly busy evening in the clinic, Ms. C was working with only 1 other clinician, Dr. P, to see to a large group of patients. 



Continue Reading

One of Ms. C’s patients that evening was Mr. D, a 23-year-old graduate student, who complained of fever, chest pains, and cough. His temperature was 101°F. He said that he had been unwell for the last couple of days. 


Ms. C performed a brief examination and gave Mr. D a diagnosis of bronchitis, providing him with a prescription for an antibiotic. Ms. C told Mr. D to get some rest, start taking the antibiotic, and come back in to the clinic if he did not feel better in a couple of days. 


The next morning, when he did not show up at school, some friends went to check on Mr. D and found him dead in his bed. In the weeks that followed, medical examiners identified Mr. D’s cause of death as myocarditis.


Ms. C was unaware of what had happened to her patient until several months later when she was notified that the clinic had been sued because of the untimely death of Mr. D and that the plaintiffs (Mr. D’s family) were alleging his death was the result of Ms. C’s negligent treatment.

The defense attorney who was representing the clinic explained to Ms. C that this was a medical malpractice case, which is really the tort of professional negligence. In such a case, the plaintiff would have to prove all of the following 5 elements to be successful: 1) a duty was owed to the patient; 2) that duty was breached; 3) the breach caused an injury; 4) the practitioner deviated from the accepted standard of care; and 5) that damage occurred because of it. 


Settlement negotiations failed, and the case went to trial. At trial, the plaintiffs introduced expert testimony establishing that Mr. D’s cause of death was myocarditis, a condition that would have been identified if an electrocardiogram had been obtained. The plaintiffs also established that the clinic had an electrocardiogram machine and could have easily administered the test. 


Ms. C was called to testify. On direct examination by her own attorney, she described her brief interaction with Mr. D. Ms. C stated that she did not suspect myocarditis because of the patient’s age and his other symptoms, particularly the cough. However, on cross-examination, Ms. C was forced to admit that Mr. D had complained of chest pains and that typically, when a patient makes such a complaint, an electrocardiogram is ordered. 


The plaintiffs’ expert testified that once the patient had complained of chest pains, Ms. C was negligent when she did not order the electrocardiogram, and this fell below the standard of care required. 


The jury returned a verdict for the plaintiffs and ordered a $4.8 million award to Mr. D’s family.