Could this be considered malpractice?

[oudoc08]

---

Members don't see this ad.

A patient is witnessed to have a seizure at a business. The patient sustains head trauma in the fall and is transported to a hospital. At the hospital, the patient, who has no other significant medical history other than chronic alcoholism, is diagnosed as having acute alcohol withdrawl with DT's, which caused the seizure. The patient is now comatose with a head injury and metabolic complications secondary to the withdrawl.

It was found that the pt. had seen his primary care physician earlier in the week who made a common, off-the-cuff comment that he needed to quit drinking or he would invariably suffer health problems. Surprisingly, the pt. did. Cold turkey.

So, did the doctor, in good faith, but failing to warn him of the dangers of sudden alcohol withdrawl commit negligence?

1. Have a duty to act. (warn of the dangers of EtOH, but also warn of the dangers of sudden withdrawl)
2. Fail to act (by not doing so)
3. Sustain an injury (head injury, comatose)
4. Directly related to the duty to act (new onset of acute alcohol withdrawl symptoms seems to tie the two together)

Wow, I have to assume that somehow, even though it seems that the 4 criteria for negligence have been met, that somehow this isn't a plausible situation, otherwise, the "you need to quit drinking, quit smoking, etc." that we all tell our patients, needs to be met with some caution.
However, it doesn't seem implausible that a jury, when instructed to find only whether the above criteria had been met, would find for the plantiff. Scary.

Any thoughts? (BTW, this is an actual situation that happened at my wife's place of business with a customer that she knows the preceding information about). 😕

 

[velo]

A patient is witnessed to have a seizure at a business. The patient sustains head trauma in the fall and is transported to a hospital. At the hospital, the patient, who has no other significant medical history other than chronic alcoholism, is diagnosed as having acute alcohol withdrawl with DT's, which caused the seizure. The patient is now comatose with a head injury and metabolic complications secondary to the withdrawl.

It was found that the pt. had seen his primary care physician earlier in the week who made a common, off-the-cuff comment that he needed to quit drinking or he would invariably suffer health problems. Surprisingly, the pt. did. Cold turkey.

So, did the doctor, in good faith, but failing to warn him of the dangers of sudden alcohol withdrawl commit negligence?

1. Have a duty to act. (warn of the dangers of EtOH, but also warn of the dangers of sudden withdrawl)
2. Fail to act (by not doing so)
3. Sustain an injury (head injury, comatose)
4. Directly related to the duty to act (new onset of acute alcohol withdrawl symptoms seems to tie the two together)

Wow, I have to assume that somehow, even though it seems that the 4 criteria for negligence have been met, that somehow this isn't a plausible situation, otherwise, the "you need to quit drinking, quit smoking, etc." that we all tell our patients, needs to be met with some caution.
However, it doesn't seem implausible that a jury, when instructed to find only whether the above criteria had been met, would find for the plantiff. Scary.

Any thoughts? (BTW, this is an actual situation that happened at my wife's place of business with a customer that she knows the preceding information about). 😕

Its hard to believe that telling a pt to stop drinking would result in a malpractice suit, but I suppose stranger things have happened. There's no objective way to know whether or not a patient is so physically dependant that they will develop DTs with acute withdrawl, but if the doc had documented a long-standing history of heavy drinking, told the patient to stop, but didn't mention the possibility of withdrawl/DTs then MAYBE the pt would have a case.

If this patient and the doctor have a good raport though I doubt it will result in litigation. Unless there's some major disfunctional communication I'm sure the patient will recognize that the doctor was only acting in his best interests. Really, the patient's injuries can be looked at as self-inflicted, he wouldn't be at risk for DTs if he wasn't an alcoholic.

 

[bigfrank]

In the eyes of a trial lawyer -- ANYTHING can be considered malpractice.

 

[oudoc08]

Really, the patient's injuries can be looked at as self-inflicted, he wouldn't be at risk for DTs if he wasn't an alcoholic.

In reality though, many of the reasons that people see their doctors are self-inflicted, though failure to properly identify and treat those self-inflicted diseases can result in a finding of malpractice.

I'm mainly interested in the outcome of this case, as alcohol withdrawl is so well documented and identifiable (i.e. - if a pt. has heart disease, it's difficult to sue McDonald's, as there are so many contributing variables), but it's quite obvious and reproducible what happens when you stop using alcohol cold turkey after being a long-term abuser of EtOH."

DT's, seizures, hallucinations, etc. are all quite well-documented effects of acute EtOH withdrawl, and thus could easily be directly attributed to such.

In this particular case, I don't know if it would go anywhere legally, but it's one of those "pt's family hears that the cause is EtOH withdrawl, and the look for the cause (i.e - his doctor) that recommended the withdrawl." Some ambulance chasing b&tch shows up with a business card, and who knows.

It would be a shame to see yet another sham case go through the system, and I'm looking for helpful advice for us all to prevent good intentions from becoming unintended negligence.

On the flip side, though, it might be a good lesson for us all. Acute EtOH withdrawl CAN be a big deal physically, and it might be who of us to recognize and remember that it's not much different than stopping SSRI's, corticosteroids, or any other medication that requires a gradual tapering of dose in order to prevent deleterious sequelae.

I think part of the problem is that we get comfortable with the sometimes mistaken notion that nobody ever listens to us or takes our advice when it comes to their social vices anyways, so for the hell of it, we just throw a "you know you need to quit smoking/drinking/etc. into each social history" just to have done it, but in reality we don't really believe or think that the chronic alcoholic or 50pack/year smoker is actually going to give it up. This might be a lesson to reconsider that notion.

 

[velo]

I still say whether or not there will be any litigation depends LARGELY on what type of relationship the physician and patient have. If it is strong I doubt the patient will seek legal action.

Whether there is any merit to litigation is, I think, almost beside the point. Its expensive either way.