165K in Brooklyn??

[BoardingDoc]

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Twin Cities jury awards $20M in malpractice case for woman who died after giving birth

Her family claimed an ER nurse failed to diagnose sepsis.

www.startribune.com

This case was an absurd miss. Is the payout huge? Yes. Did the NP completely and utterly **** up? Yes.
Some highlights from the medical record:
Pt comes to the ED 4 days after a NSVD with reported fevers of 101.8 at home. Afebrile in triage with a temp of 99.3 after tylenol/motrin at home.
Tachy to 115.
Complaining of pelvic/rectal pain.
TV U/S was equivocal
WBC 18.8.
4.3% bands
Plts 50
UA shows: No bacteria, 12 WBCs.

Diagnosis: UTI. Home with a shot of CTX and an Rx for amox.
Comes back septic with (duh) endometritis. Dies.

Details here for the curious

 

[Listen2Savage]

This case was an absurd miss. Is the payout huge? Yes. Did the NP completely and utterly **** up? Yes.
Some highlights from the medical record:
Pt comes to the ED 4 days after a NSVD with reported fevers of 101.8 at home. Afebrile in triage with a temp of 99.3 after tylenol/motrin at home.
Tachy to 115.
Complaining of pelvic/rectal pain.
TV U/S was equivocal
WBC 18.8.
4.3% bands
Plts 50
UA shows: No bacteria, 12 WBCs.

Diagnosis: UTI. Home with a shot of CTX and an Rx for amox.
Comes back septic with (duh) endometritis. Dies.

Details here for the curious

So they sued the NP?
Any supervising doc get hamstringed?

 

[BoardingDoc]

So they sued the NP?
Any supervising doc get hamstringed?

No supervising doc mentioned in the document that I can see. Maybe they can practice solo there? She did consult the on call OB and the document I linked goes into significant detail (from the plaintiff) saying that if the NP had told the on call OB doc all of the data (WBC, plts, pelvic pain etc etc) the patient never would have been sent home. They basically say: the NP completely screwed the pooch, omitted vital information in her conversation with OB and this is entirely her fault.

 

[Listen2Savage]

No supervising doc mentioned in the document that I can see. Maybe they can practice solo there? She did consult the on call OB and the document I linked goes into significant detail (from the plaintiff) saying that if the NP had told the on call OB doc all of the data (WBC, plts, pelvic pain etc etc) the patient never would have been sent home. They basically say: the NP completely screwed the pooch and this is entirely her fault.

If she consulted the OB, shouldn't they have asked lol.

You're just gonna take some crap presentation and not ask questions? Look in the EMR?

idk seems weird

 

[Splenda88]

People die when we let NURSES practice medicine...

 

[thegenius]

This case was an absurd miss. Is the payout huge? Yes. Did the NP completely and utterly **** up? Yes.
Some highlights from the medical record:
Pt comes to the ED 4 days after a NSVD with reported fevers of 101.8 at home. Afebrile in triage with a temp of 99.3 after tylenol/motrin at home.
Tachy to 115.
Complaining of pelvic/rectal pain.
TV U/S was equivocal
WBC 18.8.
4.3% bands
Plts 50
UA shows: No bacteria, 12 WBCs.

Diagnosis: UTI. Home with a shot of CTX and an Rx for amox.
Comes back septic with (duh) endometritis. Dies.

Details here for the curious

completely agree. did the NP even do a pelvic? fever, leukocytosis with a weak bandemia? A pelvic exam would surely produce CMT.

And who gives amox for UTI in adults?

I dunno when she came back septic, was a day or two later? I find it interesting (physiologically) that she died. A young (and I presume healthy) woman dying of sepsis...these days with pressors and all the critical care we have seems very, very unlikely. But it can happen.

 

[thegenius]

If she consulted the OB, shouldn't they have asked lol.

You're just gonna take some crap presentation and not ask questions? Look in the EMR?

idk seems weird

It's one of the reasons why calling a consult, largely for the purpose of putting them on the chart, is not particularly protective.

The consult can always say, in court, "well, if the EP told me the WBC is 18, or they had CMT, I would have gladly consulted on the patient."

There is never a record of exactly what was said (unless the phone call is recorded)

 

[Splenda88]

completely agree. did the NP even do a pelvic? fever, leukocytosis with a weak bandemia? A pelvic exam would surely produce CMT.

And who gives amox for UTI in adults?

I dunno when she came back septic, was a day or two later? I find it interesting (physiologically) that she died. A young (and I presume healthy) woman dying of sepsis...these days with pressors and all the critical care we have seems very, very unlikely. But it can happen.

NURSES

 

[Hamhock]

So they sued the NP?
Any supervising doc get hamstringed?

It looks like they may have tried:

Quoted from the article, "Attorney Chris Messerly, who along with Elizabeth Fors represented the family, said the defense admitted during the trial that there was negligence in Bermingham's care in the emergency room but blamed doctors."

And it seems like the NP and the physician group were both sued. So, in a way, physicians were sued for this. I wonder if the NP discussed the case with a physician.

HH

 

[thegenius]

No supervising doc mentioned in the document that I can see. Maybe they can practice solo there? She did consult the on call OB and the document I linked goes into significant detail (from the plaintiff) saying that if the NP had told the on call OB doc all of the data (WBC, plts, pelvic pain etc etc) the patient never would have been sent home. They basically say: the NP completely screwed the pooch, omitted vital information in her conversation with OB and this is entirely her fault.

The NP screwed up. The patient was sick but I can see from the vitals alone that it could be construed that the patient wasn't that sick.

First visit (seen by NP):....................................…Temp: 99.3, BP: 121/86, HR 115, RR 16, SpO2 96%
Second visit (seen by EP), 24 hours later:....Temp: 98.6, BP: 115/82, HR 123, RR 18

She was admitted, given IVF, broad spectrum Abx, had a hysterectomy, went quickly into worsening MSOF and died 2 days after being admitted.

 

[DrGasPasser]

It's one of the reasons why calling a consult, largely for the purpose of putting them on the chart, is not particularly protective.

The consult can always say, in court, "well, if the EP told me the WBC is 18, or they had CMT, I would have gladly consulted on the patient."

There is never a record of exactly what was said (unless the phone call is recorded)

If she consulted the OB, shouldn't they have asked lol.

You're just gonna take some crap presentation and not ask questions? Look in the EMR?

idk seems weird

So, this is one of those cases where the term consult is probably being used a little too liberally. She discussed the case with OB via telephone, but there was no formal bedside consultation from what I can tell.

Here is some advice to young EPs starting out - be very careful with near post-op and postpartum patients having abnormal vitals. These patients generally deserve a real, bedside consult and not just a phone curbside. In fact, my call to the OB would have started with, “Hello, this is Dr. GP and I have a consult request for a patient who needs to be admitted...” just so they understand my expectations.

You will be amazed at how different the recommendations are on the phone vs. after coming and seeing the patients themselves can sometimes be. Yes, I will send home some near post-op patients with normal vitals (and no concerning labs like bandemia), but it’s always with time specific follow-up with 24 hours. This NP screwed the pooch on many different levels.

 

[miacomet]

We've destroyed our own profession, and allowed the government and CMGs to do it. When we make <200K doing this job, what's the point working any more? I'm looking at 3-5 years in the future. My choices at that point are to leave the country, or get out of clinical medicine.

Where would you go? Everywhere else has government-run medicine....

 

[GeneralVeers]

Where would you go? Everywhere else has government-run medicine....

Other countries have fewer entitled, A-hole patients. If I'm going to work in a socialized system, with high taxes, then at least I have to have some positive trade-off. In the US we will get all of the socialized badness PLUS American entitlement, patient complaints, patient satisfaction, and threat of litigation.

 

[miacomet]

Other countries have fewer entitled, A-hole patients. If I'm going to work in a socialized system, with high taxes, then at least I have to have some positive trade-off. In the US we will get all of the socialized badness PLUS American entitlement, patient complaints, patient satisfaction, and threat of litigation.

True. In England you can go to jail for medmal. But I hear Oz and Canada are pretty great.

 

[deleted109597]

True. In England you can go to jail for medmal. But I hear Oz and Canada are pretty great.

Canada is tough for most BCEM docs. Their college doesn't consider it equivalent in general.
And if you people don't stop talking about Australia...

 

[doctalaughs]

I

Calling BS on this statement.

These people also work a billion hours a year.

Oh they work hard, surgeon hours. But they make 10x what a general surgeon makes in NYC. Don’t believe me? I’m sure you have some biglaw friends- ask what the junior partners in Manhattan make. And that is small peanuts compared to the Wall Street folks.

 

[GonnaBeADoc2222]

Meh they can keep it. 2 mil in exchange for my soul? Nah. I need a lot more than that to sell out

I


Oh they work hard, surgeon hours. But they make 10x what a general surgeon makes in NYC. Don’t believe me? I’m sure you have some biglaw friends- ask what the junior partners in Manhattan make. And that is small peanuts compared to the Wall Street folks.

Sent from my Pixel 3 using SDN mobile

 

[Listen2Savage]

Meh they can keep it. 2 mil in exchange for my soul? Nah. I need a lot more than that to sell out

Sent from my Pixel 3 using SDN mobile

 

[VA Hopeful Dr]

Meh they can keep it. 2 mil in exchange for my soul? Nah. I need a lot more than that to sell out

Sent from my Pixel 3 using SDN mobile

Give it time

 

[jw3600]

Canada is tough for most BCEM docs. Their college doesn't consider it equivalent in general.
And if you people don't stop talking about Australia...

Really? Is their ER training that different?

 

[NecFasc92]

Really? Is their ER training that different?

Pretty sure it’s 5 years in length

 

[deleted109597]

Really? Is their ER training that different?

I'm not sure it's different. But it's longer, and it's their rule.

 

[jw3600]

I'm not sure it's different. But it's longer, and it's their rule.

Are there hours as residents better? F being a resident for that long.

 

[DeadCactus]

Really? Is their ER training that different?

They have a 5 year EM training for those who will work in the big urban academic center and a 3 year branch from FM for those who will work in more rural, community settings. It's not that different from the US when you consider a 3-4 year residency and a 1-2 year fellowship for those going into academics. If you've done 5 years of residency and fellowship, I believe they consider your training eligible for their boards but I think it all has to have been done in the same place.

 

[gro2001]

I


Oh they work hard, surgeon hours. But they make 10x what a general surgeon makes in NYC. Don’t believe me? I’m sure you have some biglaw friends- ask what the junior partners in Manhattan make. And that is small peanuts compared to the Wall Street folks.

I have a few big law friends. It's not exactly as you describe. First of all, its relatively few big firms that pay that kind of money (like around 40 firms that generate >1M in revenue/lawyer/year), and most lawyers are never in a career path that could even potentially end up in them becoming a partner at one of those firms. For the ones that are in the running, they are associates making like 100-200k for 7-8 years, with a chance (but no guarantee) of being selected for partner. And they are as busy if not more busy than residents the entire time.

A close friend of mine was going through this career path around the time I was in med school and residency. If I recall correctly, there were like dozens of first year associates that all knew that only likely one or two of them would be making partner at that law firm around 8 years later. Many dropped out because they couldn't handle/didn't like the work, some were fired, some left because they were given to understand that they weren't 'partner material'. By the time you are one of the senior associates, there are only a few left and then one or two of them might be offered partnership. My friend was a senior associate when all of a sudden the office politics changed. Sometimes you can make a lateral move to another firm in that case and not have to start over as a junior associate, but many people just go on to take a normal lawyer job at a small firm and make like 100k.

Considering that to even start off on this path you have to be a good student from a great law school (the hires at these kinds firms are almost exclusively from the prestigious schools), the medicine analogy is like someone doing a neurosurgery residency with no guarantee of making neurosurgeon money at the end and maybe having to go back to primary care.

 

[emergentmd]

If Avg EM makes less than 200K/yr, I am quickly switching to part time just to keep my mind sharp. No way I am working full time for 200k/yr.

Ill open up some urgent care and make that much and have some control