Mr D was feeling ill at work and decided to go home early. Over the next few hours, he developed a fever and his wife became concerned and convinced Mr D to go to the local urgent care clinic.

That evening the clinic was supervised by Ms M, a PA. When Mr D arrived at the clinic, his fever was 103 ⁰F. Mrs D told the nurse that her husband’s symptoms were fever, dizziness, cough, and fatigue. Mr D was sweating and shaking and he seemed disoriented and confused. His respiration and pulse were elevated.

When the nurse attempted to give the patient an influenza test, Mr D became combative and agitated, physically pushing the nurse away and acting as though he didn’t know what was happening to him.

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The nurse reported the situation to the PA before she walked into the examination room. In the examination room, Ms M asked the patient’s wife if the patient was on any illicit drugs or withdrawing from a substance because of his combative nature — he was not. The patient also denied experiencing a headache, nausea, or vomiting. The patient’s influenza test was negative.

The PA was aware that false negative influenza tests were possible. Because it was cold and flu season— Ms M concluded that the patient had the flu. She returned to the examination room and told the patient she believed he had the flu. Mr D was sent home with the antiviral oseltamivir phosphate, a painkiller, and instructions to return to the clinic if he didn’t improve in 5 to 7 days. The patient was dizzy and had to be taken to his car via a wheelchair and helped into the car.

Two days later, when Mr D seemed to worsen, Mrs D decided to take him to the emergency department of the nearest hospital. There he was diagnosed with acute bacterial meningitis, placed in a medically-induced coma, and transferred to the intensive care unit (ICU). After 8 days in the ICU, he was transferred to an inpatient unit where he remained for 1 month until he was discharged. During this time, Mr D experienced 3 strokes and developed brain damage because of the infection. He permanently lost hearing in his right ear and suffered nerve damage to his right leg, affecting his ability to walk.

Mr D and his wife sought counsel from a plaintiff’s attorney who advised them to sue the urgent care clinic based on the incorrect diagnosis made by its employee, the PA. A lawsuit was filed.

The Trial

Before the trial, the plaintiff’s attorney asked for a $25 million settlement for damages. The defense made no settlement offer until a week before the trial was set to begin. At that point, the defense offered $250,000 to settle the case. The plaintiffs refused and the case went to jury trial.

The trial lasted 5 days and included the testimony of 7 experts. Ms M, the PA, and Mr and Mrs D all testified.

Defense attorneys for the clinic argued that Ms M had made a reasonable diagnosis under the circumstances. Experts for the defense pointed out that Mr D lacked the severe head and neck pain that is frequently associated with meningitis. Ms M testified that she ruled out meningitis for this reason.  She settled on the influenza diagnosis because of Mr D’s fatigue, elevated pulse and respiration, fever, and reported cough. She testified that influenza tests are not completely reliable and she believed that, despite the negative result, the patient still had the flu.

Experts for the plaintiff were critical of Ms M’s diagnosis. Both Mr and Mrs D testified about how it took him months to relearn how to walk, talk, feed, and bathe himself.

After deliberating, the jury came back with a verdict for Mr D that was even higher than the $25 million the plaintiff had asked for. The jury returned a $27 million verdict against the clinic.

Protecting Yourself

One of the most challenging aspects of being a health care provider is making a proper diagnosis, which has been described as both an art and a science. A diagnosis often has to be made under challenging circumstances, with little time, and sometimes not much information.

Many conditions share similar symptoms. Influenza, in particular, shares symptoms with many other conditions including bronchitis, pneumonia, common cold, streptococcal pharyngitis, meningitis, and mononucleosis. When considering a patient’s diagnosis, it is best to first rule out the worst-case scenario rather than assume the patient is suffering from the most likely one. The patient’s symptoms — fatigue, dizziness, fever — could be caused by any number of things, so it is essential to first rule out the most dangerous conditions that require immediate attention.

Ms M should not have discounted the negative influenza result. Yes, false negatives do occur, but this was a clue that maybe it was not actually the flu, and maybe Ms M should have delved further. The fact that Mr D was exhibiting signs of disorientation and confusion and was unable to walk out of the clinic on his own should have alerted Ms M that this might be something more extreme than influenza.

There is a song lyric from a 1970s film that goes “Hope for the best, expect the worst.” This should be the mantra of the diagnostician. Even though it’s more likely not to be the case, it is better to assume that the patient may be suffering from the most dangerous of conditions and act accordingly.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.