$10 million dollar verdict for delay of care

[alphaholic06]

Thoughts? A North Texas hospital waited hours to address a spinal emergency. It led to a woman's paralysis and a $10.1 million court win for her

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[RustedFox]

Thoughts:

1. In Texas? Hmm.

2. This sets a precedent. Attention administrators: we need fast MRI access at all hours.

3. See (2) above.

 

[BoardingDoc]

Thoughts:

1. In Texas? Hmm.

2. This sets a precedent. Attention administrators: we need fast MRI access at all hours.

3. See (2) above.

It doesn't look like the lack of 24/7 MRI was the issue. It looks like the patient came to the ED with a clear likely dx of epidural hematoma after an ESI, got a stat MRI ordered within 10 min of arriving, but then took 1.5 hrs to have the MRI actually performed. It's not definite from the article, but it doesn't seem like the emergency doc was named. Looks like they went after the pain doc for the injection (settled) and the hospital for the delay in performing the MRI (lost in court).

EDIT: you said fast access, so yeah, agree that seems to be the problem.

 

[RustedFox]

It doesn't look like the lack of 24/7 MRI was the issue. It looks like the patient came to the ED with a clear likely dx of epidural hematoma after an ESI, got a stat MRI ordered within 10 min of arriving, but then took 1.5 hrs to have the MRI actually performed. It's not definite from the article, but it doesn't seem like the emergency doc was named. Looks like they went after the pain doc for the injection (settled) and the hospital for the delay in performing the MRI (lost in court).

EDIT: you said fast access, so yeah, agree that seems to be the problem.

Correct. At present, here's how I get an MRI after 5 pm for a true red flag case.

1. Order MRI.
2. Find charge nurse.
3. Charge calls rad tech 5 times.
4. Rad tech calls MRIgal at home.
5. MRI gal calls back after 2 hours and 5 phone calls to argue as to why this isn't needed or covered by protocol, hangs up.
6. Charge tells me about (5). I say: "get her skinny ass in here now".
7. Charge repeats (5).
8. I repeat (6).
9. MRIgal calls radiologist to complain.
10. I call radiologist to complain.
11. Radiologist calls MRIgal to complain.
12. MRIgal takes 2 hours to shower, put on makeup, feed dog, walk dog. Comes in.
13. MRIgal finds me, complains.
14. I complain back.
15. She takes patient, does study.
16. MRI sits unread for hours.
17. I tell charge RN to teleharass radiologist to read the study.
18. Charge RN "thinks about it", decides to take smoke break instead.
19. Charge RN returns from smoke break.
20. Repeat (17) thru (19) until we get a result.

 

[HemorrhagicShock]

Everything about this case suggests that the institution, physicians, and system were actually EXTREMELY high-functioning given the state of affairs in the average hospital across the nation.

1 hour and 37 minutes prior to getting an MRI in the ED? That is insanely fast any way you cut it.

Claiming that the orthopedic surgeon was available in the hospital when they arrived as evidence of negligence is hilarious. What ortho spine is going to cut into anything without imaging, let alone the fact that he did so at 10 pm the same day

I don't know a single orthopod who would ever operate at 10 pm. It just doesn't happen.

What interventional pain doc doesn't explicitly outline the risk of a spinal injection, and have them sign an extensive set of consent paperwork, especially for an older-aged Karen like this?

All of this is trash, and fully supports the notion that many of us have - it's not about justice, but about using the med mal system as a means of obtaining restitution at the cost of a physician's and hospital's license and reputation. The entire thing needs to be torn down and built from scratch.

Until that happens we are all just "walking through the minefield with clown shoes."

 

[EthylMethylMan]

Glad it looks like the ED doc wasn't named. But the writer seems to imply that the ED doc didn't call the spine surgeon until the MRI resulted? I dunno what her exam looked like, but with her story and symptoms spine should've been called before she even went to the MRI suite. Other than that, the ED doc looks like the most innocent person here, second to the surgeon.

The community ED we rotated at in residency would usually get an MRI done within an hour of ordering it, assuming it wasn't some pan-neuraxis nonsense. It was fantastic.

 

[Janders]

If you showed me the timeline in the article, without telling me it was a malpractice case, I would say the hospital did a solid job getting a rapid MR and surgical case going.

Its not like we have multiple MRIs and Spine surgeons standing around ready to slice spines in <60min the way cath labs are set up. Clearly it would be cool if we did, but it is NOT the standard of care.

Subtext in the article is that hospital policies can **** you. They had a policy that STAT/Emergent OR cases start in <60min and this one didn’t (who knows why, anesthesia, surgeon, flipping room, getting a nurse in). They still went quickly, but violated their own internal policy which was held against them. I have seen this before.

 

[pkwraith]

They bold and italicize "1 hour and 37 minutes" like it is a scandalizing shock. I would second that this is reasonably fast.
Another example that law suit cases aren't won based on the merit of the cases.

 

[johhnybgood]

They bold and italicize "1 hour and 37 minutes" like it is a scandalizing shock. I would second that this is reasonably fast.
Another example that law suit cases aren't won based on the merit of the cases.

I’d say that this is relatively quick and expedious care. Not sure where this could be done quicker or more efficiently. Certainly no where I work. What a joke.

 

[EthylMethylMan]

They bold and italicize "1 hour and 37 minutes" like it is a scandalizing shock. I would second that this is reasonably fast.

Evokes the same feeling I get when I walk into an ESI 4 or 5 room, and the first thing I hear is, "I'm very frustrated. I've been here two hours and you're the first doctor I've seen."

 

[Jabbed]

Very surprising that this verdict was rendered in Texas. I cannot fathom how they were able to make that argument that a door-to-scalpel time of 5 hours was the direct cause of her permanent paralysis. I did a quick lit review and all I could find were studies from 1995 showing that OR in <12 hours is better than OR in >12 hours.

Other than that, another great case of how $urgi$enter$ are maiming patients and leaving the rest of us to hold the bag.

 

[PianoMedic]

Correct. At present, here's how I get an MRI after 5 pm for a true red flag case.

1. Order MRI.
2. Find charge nurse.
3. Charge calls rad tech 5 times.
4. Rad tech calls MRIgal at home.
5. MRI gal calls back after 2 hours and 5 phone calls to argue as to why this isn't needed or covered by protocol, hangs up.
6. Charge tells me about (5). I say: "get her skinny ass in here now".
7. Charge repeats (5).
8. I repeat (6).
9. MRIgal calls radiologist to complain.
10. I call radiologist to complain.
11. Radiologist calls MRIgal to complain.
12. MRIgal takes 2 hours to shower, put on makeup, feed dog, walk dog. Comes in.
13. MRIgal finds me, complains.
14. I complain back.
15. She takes patient, does study.
16. MRI sits unread for hours.
17. I tell charge RN to teleharass radiologist to read the study.
18. Charge RN "thinks about it", decides to take smoke break instead.
19. Charge RN returns from smoke break.
20. Repeat (17) thru (19) until we get a result.

I don’t work in Florida, but it’s like we work at the same hospital sometimes…

 

[cyanide12345678]

5 hours from door to OR. Quite honestly, that’s not that bad, especially since there was an MRI done in between.

Come to my shop and I’ll spend 5 hours just to find a transfer facility and an available ambulance to get the patient transferred 😂😂 everywhere is full again -_-

 

[RustedFox]

5 hours from door to OR. Quite honestly, that’s not that bad, especially since there was an MRI done in between.

Come to my shop and I’ll spend 5 hours just to find a transfer facility and an available ambulance to get the patient transferred 😂😂 everywhere is full again -_-

Every hospital between SouthCity and BiggerNorthCity 3 counties away is on transfer closure.

 

[RustedFox]

Re: door-to-whatever time of 1h 37m.

That's totally reasonable.
*Shaggy voice*
"Zoinks, Scoob. Like, there's no way to win this one."

 

[southerndoc]

Ironic considering the recent quality study of ER docs being the 4th leading cause of death in America.

In all seriousness, this is an unfortunate case. Counsel and jurors have no idea how hard it is to get an MRI -- even "emergently." Most facilities aren't capable of performing them 24/7, and even in my comprehensive stroke center with a fully staffed 24/7 MRI dedicated solely to ED use, if you have another spine or stroke patient on the MRI table, it can be >90 minutes before the next study occurs.

I think probably the tipping point for the jurors was the ER RN calling the MRI tech and the MRI tech clocking out 23 minutes after being told there was a STAT MRI to leave it for the next person to deal with.

 

[southerndoc]

I’d say that this is relatively quick and expedious care. Not sure where this could be done quicker or more efficiently. Certainly no where I work. What a joke.

I agree, but the fact that the MRI tech clocked out requiring them to call in a tech to complete the study probably made the jury see it in a different light. Yes, normally it takes a long time to get MRIs. In this case, had that MRI tech just stayed over 20 minutes, the MRI would've been done immediately.

 

[RustedFox]

I agree, but the fact that the MRI tech clocked out requiring them to call in a tech to complete the study probably made the jury see it in a different light. Yes, normally it takes a long time to get MRIs. In this case, had that MRI tech just stayed over 20 minutes, the MRI would've been done immediately.

But we both know that there would be no way to get that MRI tech to stay, which then puts us in my 20 step algorithm above.

 

[southerndoc]

But we both know that there would be no way to get that MRI tech to stay, which then puts us in my 20 step algorithm above.

You and I know that, and we also know how eager someone can be to leave when you've dedicated your whole day to others and want some family time, but a jury does not see it that way. The extra time cost this person her ability to walk. That's how they view it.

 

[CoolDoc1729]

I agree, but the fact that the MRI tech clocked out requiring them to call in a tech to complete the study probably made the jury see it in a different light. Yes, normally it takes a long time to get MRIs. In this case, had that MRI tech just stayed over 20 minutes, the MRI would've been done immediately.

I wonder how many of the jurors are frequently asked to stay 1-2 hours over the end of their shift - if any of them work at all

This is actual insanity to be complaining that an after hours case took 5 hours to get an mri done and resulted and a surgeon to the bedside then to OR.

At my hospital this would require at least 6 people to drop everything for several hours for a total stranger. Mri tech then OR team then NS and assistant. There’s not a chance on earth I’d get that to happen in 5 hours.

Bad things happen, to everyone at least once in their life, it can’t always be someone’s fault. It would be nice if the Public ever gave medical providers the benefit of the doubt. This is really upsetting.

 

[RustedFox]

You and I know that, and we also know how eager someone can be to leave when you've dedicated your whole day to others and want some family time, but a jury does not see it that way. The extra time cost this person her ability to walk. That's how they view it.

Oh, I don't disagree. At all.

 

[NYEMMED]

Also calls ASCs into question.

If this procedure was done in the hospital, would MRI and treatment have occurred faster than being sent by EMS to the ED?

Personally I’m tired of cleaning up after my nearby ASC.

 

[Mount Asclepius]

On face value, the care in this case was above the standard of care in my opinion. Good luck ever getting an epidural hematoma to the OR faster.

This case also demonstrates that a bad outcome and an angry patient trumps good medical care in the medicolegal system.

This thread demonstrates that we as a country are heading for a reckoning. Costs are spiraling out of control because people can’t accept that perfect health isn’t guaranteed, your personal health choices have consequences, and interventions to try to correct those choices sometimes can be flawed.

 

[turkeyjerky]

Between the recent chriopractic dissection case and this one, I'm getting sick of hearing about hospitals and ERs getting held accountable for the mistakes and complications of unnecessary outpatient procedures, when the actual ****ups probably get off w/ a token payment.

 

[Brigade4Radiant]

Glad it looks like the ED doc wasn't named. But the writer seems to imply that the ED doc didn't call the spine surgeon until the MRI resulted? I dunno what her exam looked like, but with her story and symptoms spine should've been called before she even went to the MRI suite. Other than that, the ED doc looks like the most innocent person here, second to the surgeon.

The community ED we rotated at in residency would usually get an MRI done within an hour of ordering it, assuming it wasn't some pan-neuraxis nonsense. It was fantastic.

Why would spine be consulted before the MRI? It would have just delayed things even further

 

[Rekt]

Unbelievable. There's no way that happens any faster at all. I have 24/7 MRI and it still would not be that fast. What about the thousands of hospitals that don't even have MRI capabilities? It takes 5hrs just to set up a transfer.

The problem is the jury of "peers" which is just the general public who as we know are complete *****s. How about a panel of physicians instead.

 

[turkeyjerky]

Why would spine be consulted before the MRI? It would have just delayed things even further

Seeing all these crazy spine related malpractice reports has made me super paranoid on a occasion. I'll sometimes order imaging and call neuro/ortho at the same time.

 

[RustedFox]

Seeing all these crazy spine related malpractice reports has made me super paranoid on a occasion. I'll sometimes order imaging and call neuro/ortho at the same time.

I do this. Every time.

"Hey, SpineBro. Ordering MRI now for what looks to be the real deal. Stay frosty."

 

[Nephro critical care]

I think everything was done pretty fast. If it happened at my hospital I would be completely SOL. Other than the fact that I am in Indiana. Our MRI techs argue about everything if I want to add on a study at the end of the day. One time I needed a stat MRI study so I called MRI myself and said I wanted a stat exam. They said fine they could do the study. I brought the patient down myself and MRI techs were furious they said they blow off stat studies all the time; nothing is stat. Stat means it will be done that day.

One of the problems is that radiology techs are very poorly paid. When someone is paid peanuts they are going to be less motivated to do a good job. They could always leave and go to work at McDonald's. Would not be much difference in pay.

 

[emergentmd]

This is the classic time bomb and whoever touched it last gets hurt. This is typical with med mal. Sympathetic person, bad outcome, find reason, Jury told insurance will pay, awards large amount. I am sure this will be negotiated down.

Imagine getting 10 doc jurors on a case dealing with Quantum physics and if Particle G's speed actually turns back time when looking at Particle G's perspective. You have two quantum physics witness and no matter how dumb down the topic is, you have no idea what they are talking about.

Come back to deliberation and you see a sympathetic person paralyzed. Yeah, I may vote for the insurance company to pay 10M too.

 

[southerndoc]

I really wish nationally we would have tort reform where all states and federal court cases require a panel of docs to review before litigation could proceed. That would eliminate a lot of litigation provided they don't have these guns for hire review cases. Should be random sampling of same specialty docs practicing in that state.

 

[RuralEDDoc]

Why would spine be consulted before the MRI? It would have just delayed things even further

Agreed. Alerting the surgeon doesn’t do what needs to be done, which is getting an imaging diagnosis. It’s not like the spine surgeon is going to call in the OR staff with your exam findings.
It’s like calling a urologist for every testicle pain. I did that once in the community when I was right out of residency and the urologist told me to never call him with a symptom, he wants a diagnosis. Ok cool, makes sense.

 

[Zebra Hunter]

I really wish nationally we would have tort reform where all states and federal court cases require a panel of docs to review before litigation could proceed. That would eliminate a lot of litigation provided they don't have these guns for hire review cases. Should be random sampling of same specialty docs practicing in that state.

Louisiana requires medical review panel prior to proceeding to litigation. Does nothing to prevent frivolous suits, even when the medical review panel rules unanimously in your favor…ask me how I know.

 

[turkeyjerky]

How about a system where every patient gets to either opt in or opt out of auto-indemnification for economic costs related to complications from procedures or malpractice. No jackpot verdicts however, but you know you won't be left destitute as a result of a misdiagnosis or complication. You would think the AHA and professional societies could get behind this.

Agreed. Alerting the surgeon doesn’t do what needs to be done, which is getting an imaging diagnosis. It’s not like the spine surgeon is going to call in the OR staff with your exam findings.
It’s like calling a urologist for every testicle pain. I did that once in the community when I was right out of residency and the urologist told me to never call him with a symptom, he wants a diagnosis. Ok cool, makes sense.

I agree with you. However, it does create a record of you taking the patient seriously and trying to do w/e you can in the constraints of the system you work in.

 

[Nephro critical care]

I really wish nationally we would have tort reform where all states and federal court cases require a panel of docs to review before litigation could proceed. That would eliminate a lot of litigation provided they don't have these guns for hire review cases. Should be random sampling of same specialty docs practicing in that state.

These outrageous verdicts damage society in general. They scare doctors in general who then practice defensive medicine and spend gazillions. It may be inappropriate to put a 95 year old demented person on a ventilator but everyone is afraid of a jackpot verdict and they do whatever the family wants.
It leads to a system where I need to pay $1600 a month to purchase health insurance for my family and thus I am dependent on my employer to cover health insurance costs.

 

[DeadCactus]

I guess I'm the only one not outraged that a hospital was held accountable for useless administrators coming up with nonsense policies and then failing to actually staff in a way that makes them feasible. This wasn't some subtle presentation that got missed. And it's not like there was some unavoidable delay in care, it's the same garbage staffing and culture to maximize profits that we see everywhere.

And is this really the same hospital that sent the Ebola patient home after he presented with fever and a history of travel to an area with an active Ebola outbreak?

 

[Siggy]

I wonder if this is a "somebody has to pay" case.

There's two types of "somebody has to pay."

1. Someone screwed up, now you have to pay to make up for your error. This doesn't seem to be the case.

2. Patient permanently injured and now needs care/aid/deal with loss of income. Someone has to pay for that care/rehab/assistance devices. It's not personal (it's not even right), but someone needs to take care of the patient. Unfortunately death can mean less likely to have a jackpot verdict... or even a lawsuit. Mortality means no acute rehab, wheel chair, PT/OT, chronic pain, future hospitalizations, etc.

 

[Birdstrike]

Bad outcome + sympathetic plaintiff = big award

Standard of care matters little.

Hospitals get sued too. And if the EM doc wasn’t, that’s good news.

In cases like this, the only winners are the lawyers.

 

[HemeOncHopeful19]

I guess I'm the only one not outraged that a hospital was held accountable for useless administrators coming up with nonsense policies and then failing to actually staff in a way that makes them feasible. This wasn't some subtle presentation that got missed. And it's not like there was some unavoidable delay in care, it's the same garbage staffing and culture to maximize profits that we see everywhere.

And is this really the same hospital that sent the Ebola patient home after he presented with fever and a history of travel to an area with an active Ebola outbreak?

I agree but the idea that ANY of the physicians involved had to settle and will need to report this on all future paperwork is a complete clown show.

 

[namethatsmell]

How about a system where every patient gets to either opt in or opt out of auto-indemnification for economic costs related to complications from procedures or malpractice. No jackpot verdicts however, but you know you won't be left destitute as a result of a misdiagnosis or complication. You would think the AHA and professional societies could get behind this.

This is a great idea. Where would the money come from to fund the auto-indemnification pool? If it's from docs, they could require all their patients to agree to participate as part of the treatment agreement, or they'd be free to seek care elsewhere.

 

[HemeOncHopeful19]

Laws are written by lawyers.

Tort reform would be bad for their industry.

You’ll know we actually have a “doctor shortage” when states start enacting tort reform to try and attract more docs. Nevada did this in the past supposedly when the state got so bad that it did not have a single neurosurgeon.

 

[RustedFox]

I guess I'm the only one not outraged that a hospital was held accountable for useless administrators coming up with nonsense policies and then failing to actually staff in a way that makes them feasible. This wasn't some subtle presentation that got missed. And it's not like there was some unavoidable delay in care, it's the same garbage staffing and culture to maximize profits that we see everywhere.

And is this really the same hospital that sent the Ebola patient home after he presented with fever and a history of travel to an area with an active Ebola outbreak?

Yeah, I thought about this, too - but wasn't sure how to phrase it well.

1. ER doc - "I'm here, and ordered the correct study immediately."
2. Surgeon - "I'm here, and waiting for the result so I can cut-to-cure."
3. I'm a hospital, and I can't staff correctly... I'm... [ ? ].

 

[JacobMcCandles]

The hospital should be the ones getting paid $10M for getting the MRI done that fast.

 

[RuralEDDoc]

I agree with you. However, it does create a record of you taking the patient seriously and trying to do w/e you can in the constraints of the system you work in.

Yes. But so does ordering a stat study a documenting efforts to make it happen stat. There’s not a right or wrong answer here. I just don’t want to call a spine surgeon with 5 phony “heads up” calls for every real deal. I want that spine surgeon operating, not responding to a bunch of questionable heads up calls. YMMV based on local conditions.
With that said - I work in California. Decent malpractice environment. When I sit next to docs who trained in New York, I’m appalled by their consults. “Wanna run this case by you”, only to hear a benign presentation of a common condition. Still floors me after 10+ years. These are good docs with good judgement, and I have to believe a New York training and malpractice culture is a causal factor here.

 

[Kryptocoin]

From door to surgery was 5hrs. How could they prove that she would have had a better outcome if it had been done an hour or two sooner?

Also, "willful and wanton" negligence is a pretty high bar. So the hospital willfully neglected her? Hmmh...

Thankfully the ER doc was not named. If this were in other non-tort reform states, he/she would have definitely been named.

 

[cyanide12345678]

I got named in a lawsuit once for literally attending a code blue as a resident, didn’t even run it as the cardiology fellow ran it. Really surprising they didn’t name every single person whose name was on the chart.

I’m just glad to be in a state where a panel of doctors reviews cases and approves them before they can proceed further. Plus i believe the state has a fund for jackpot verdicts to protect doctors.

I’m just very surprised this sort of verdict came out of Texas. I mean…give the lady 1 million. But 10 million? Seems excessive. I would understand a 10 million dollar verdict if it was a 20 year old patient.

 

[emergentmd]

It’s like calling a urologist for every testicle pain. I did that once in the community when I was right out of residency and the urologist told me to never call him with a symptom, he wants a diagnosis. Ok cool, makes sense.

I remember being trained that if you clinically suspect appendicitis that labs/CT doesn't matter and call the surgeon to consult.

Soon after being an attending, classic appy with fever/elevated WBC. CT prob takes another 2 hrs. Called the surgeon, and he says, "sounds like an appy, call me when the CT comes back"

 

[CoolDoc1729]

I remember being trained that if you clinically suspect appendicitis that labs/CT doesn't matter and call the surgeon to consult.

Soon after being an attending, classic appy with fever/elevated WBC. CT prob takes another 2 hrs. Called the surgeon, and he says, "sounds like an appy, call me when the CT comes back"

Also in training they would actually take the appys at night if the trauma surgeon wasn’t busy - whereas I can’t remember the last time an appy went to OR between 1900 and 0700 at my current place. I mean technically if one perforated during that time would that be “wanton and willful negligence”? Because it’s happening several times a week

 

[thegenius]

Thoughts? A North Texas hospital waited hours to address a spinal emergency. It led to a woman's paralysis and a $10.1 million court win for her

I wonder if a spinal surgeon these days will ever do surgery without an MRI, and whether any other spinal surgeons would be paid expert witnesses to say that MRI is just delaying care.

It appears that NSG depends 100% on MRIs before spinal surgery.

 

[thegenius]

Bad things happen, to everyone at least once in their life, it can’t always be someone’s fault. It would be nice if the Public ever gave medical providers the benefit of the doubt. This is really upsetting.

Word.