Ms. P, aged 27 years, was a nurse practitioner who recently started working at a regional health care center. She had been there six months, and as the junior staff member, she was often assigned the worst hours — weekends and nights. 

Her experience was somewhat limited. Ms. P had only held one position before and that was in a pediatrician’s office, so she was careful to consult with her supervising physician, Dr. S, when she had any questions. Although she believed that Dr. S was an adequate supervisor, their interactions were frequently hurried conversations in the hallway, as both of them were extremely busy. 

One day, Dr. S was overbooked and asked Ms. P to see a patient who had come in complaining of diarrhea. Ms. P went to the examination room and spoke to the patient, Mr. F, aged 56 years. 

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Mr. F told Ms. P that he had had diarrhea for the last two weeks. He had no other complaints, but his medical history included hypertension and a kidney transplant. After examining the patient, Ms. P sought out Dr. S to discuss treatment. After consulting with the physician, Ms. P prescribed metronidazole and verbally informed the patient to report back in 48 hours on how he was feeling. 

The patient did not return or call after 48 hours, but nine days later, he called the office saying that the medicine was making him feel “worse, rather than better.” He was told to continue taking the medication as instructed. 

The following day, Mr. F collapsed at home and was taken by ambulance to a nearby hospital, where he later died. The cause of death was “acute cardiovascular event.”

Mr. F left behind three adult children. After the children grieved the loss of their father, they became increasingly angry about the series of events leading to his death. The family lived in a state where all potential medical malpractice cases must go before a medical review panel before a lawsuit can be filed. The panel is comprised of clinicians — doctors and nurses — who have six months to examine the evidence and order discovery, including depositions, and the production of documents and records. The medical review panel then can make one of three decisions: 1) the evidence demonstrates that the clinician breached the standard of care; 2) the evidence demonstrates that the clinician did not breach the standard of care; or 3) a question of fact exists bearing on the issue of liability and thus, the medical review panel cannot render a decision.

The review panel examined the actions of Ms. P and Dr. S, and ruled that “although unfortunate,” there was “no breach in the standard of care by either of the defendants.” Specifically, the panel found that the treatment, including metronidazole, was within the standard of care.

Despite this finding, Mr. F’s children pursued a medical malpractice case against Ms. P and Dr. S. The clinicians sought the advice of a defense attorney provided by their malpractice insurance. The attorney reassured them that he believed that they had an excellent chance of getting the case dismissed based on lack of causation.

“The plaintiffs would have to be able to show that your negligence had caused Mr. F’s death,” he said. “This will be very difficult to do, especially once the medical review panel has said that you did not breach the standard of care.”