In this issue:
Perspective: Is a ruptured appendix evidence of malpractice?
By Charles A. Pilcher MD FACEP
Appendicitis is the most common acute abdominal surgical condition in medicine, yet there is probably not a single physician in practice today who hasn’t missed the diagnosis at least once. Often that results in “simple” appendicitis becoming a “ruptured” or “perforated” appendix. Attorneys are often confronted with this situation, but when is it malpractice to miss the diagnosis of appendicitis? Read more ->
Do you have issues? Suggest a topic for “Perspectives”
Reader input has led to several of the “Perspective” articles like the one above that have appeared in Medical Malpractice Bulletin over the years. If you would like to offer an essay for publication or suggest a topic for review, please contact me.
Florida ruling jeopardizes EMS services nationwide
A Volusia County, Florida, jury recently returned a $10 million verdict against the ambulance company that provided emergency transport of a pregnant woman in premature labor. The mother was being transported to a tertiary care center when she delivered a 25 week fetus 15 minutes into the trip. The baby was successfully resuscitated by the transporting EMS crew but suffered severe brain damage. The appeal of this verdict is being watched closely by EMS agencies across the country for its potential impact on transport decisions and care.
Diagnostic or screening mammogram? Whose call is it?
A patient was referred to a radiologist for a “screening mammogram” for a (presumably self-reported) lump in her breast. A lump normally requires a “diagnostic mammogram.” When the ordering physician was called by the mammography tech to change the order, the doctor declined. The radiologist claims that to override or re-write such an order would constitute Medicare fraud. Reality check: Has the radiologist ever heard of the telephone? A simple call from the radiologist explaining the standard of care to the ordering physician should clear up any misunderstanding.
Is a plaintiff expert necessary? Kentucky Supreme Courts says “Yes” — but barely.
The Kentucky Supreme Court in February agreed that an expert witness is required by a plaintiff who brings a medical malpractice suit against a physician and/or hospital. Though the facts of the case suggested it had little merit, the fact that only 4 of the Court’s 7 justices joined in the majority decision to support the trial court’s summary judgment for the defense is shocking.
X-Rays of hip and pelvis miss 1/3 of fractures.
Kirby and Spritzer in the American Journal of Roentgenology report that routine x-rays failed to detect 35 hip or pelvic fractures in 28 of 92 patients undergoing subsequent MRI. Note that the fact that these patients underwent an MRI suggests that physicians had a high clinical suspicion, despite the normal x-rays.
OOPS. Nurse settles for $1 million just before jury returns defense verdict
As the jury was deliberating, a nurse in a NY malpractice case and her attorney agreed to a $1 million settlement. Shortly thereafter the jury reported that they had reached a defense verdict, too late for the nurse. Key lesson: Juries are unpredictable.
Fatal medication errors increase in July at teaching hospitals
Researchers at the University of California San Diego report that fatal medication errors peak in July only in counties with teaching hospitals. The authors attribute the 10% increase to the influx of new resident trainees. The article in the Journal of General Internal Medicine is one of the few to substantiate the so called “July effect.” Other causes of death were not affected.
Can filing an EMTALA claim open the door to peer review documents?
This one deserves some feedback from readers. An anonymous individual blogging on malpractice issues as an “expert witness” claims that by filing an EMTALA claim, plaintiff attorneys can remove the protected status of peer reviewed material related to the case. The writer says “the federal rules of evidence allow the plaintiff attorney access to the normally off limit peer review material which then can be used in the State medical malpractice action.” I find that hard to believe/Editor. Add a comment, or Send me your thoughts.