Medical discharge in medical emergency

[DocArmy]

From this week's Army Times: Pg. 35
"RETIREE AWARDED $1M IN MALPRACTICE LAWSUIT
Retired Chief Operations Spe*cialist (SW) Edward Brock will receive a nearly $1 million settle*ment after filing a lawsuit claim*ing that Naval Hospital Jack*sonville, Fla., misdiagnosed him, leading to swelling that forced doctors to remove part of his brain. Brock, 42, of Jacksonville, is now “permanently and totally disabled,” said Sean Cronin, Brock’s attorney.
Brock was awarded a $625,000 cash settlement along with monthly payments of $1,600 for the rest of his life, an annuity val*ued at about $325,000. The settle*ment was approved Aug. 3.
The lawsuit claimed that doctors misdiagnosed Brock’s headache as viral meningitis March 20, 2007, and discharged him March 22. On March 24, Brock went to a civilian*run hospital, where he was correct*ly diagnosed with viral encephali*tis, Cronin said."

Why was this man discharged so rapidly? It seems fishy that he would go to the hospital, be sick, get teh boot, and then figure out that he is seriously ill. My issue is not necessarily with the misdiagnosis, but with the seeming haste in getting this guy out of the military at what I understand is warp speed as far as paperwork goes.

Now, I am just a medical student, and don't have a lot of experience in the medical corps, but my reading on this site and other limited experience make me question whether this type of action may in fact be standard procedure. If a servicemember is seriously ill, why the propensity to separate them so quickly?

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[orbitsurgMD]

From this week's Army Times: Pg. 35
"RETIREE AWARDED $1M IN MALPRACTICE LAWSUIT
Retired Chief Operations Spe*cialist (SW) Edward Brock will receive a nearly $1 million settle*ment after filing a lawsuit claim*ing that Naval Hospital Jack*sonville, Fla., misdiagnosed him, leading to swelling that forced doctors to remove part of his brain. Brock, 42, of Jacksonville, is now “permanently and totally disabled,” said Sean Cronin, Brock’s attorney.
Brock was awarded a $625,000 cash settlement along with monthly payments of $1,600 for the rest of his life, an annuity val*ued at about $325,000. The settle*ment was approved Aug. 3.
The lawsuit claimed that doctors misdiagnosed Brock’s headache as viral meningitis March 20, 2007, and discharged him March 22. On March 24, Brock went to a civilian*run hospital, where he was correct*ly diagnosed with viral encephali*tis, Cronin said."

Why was this man discharged so rapidly? It seems fishy that he would go to the hospital, be sick, get teh boot, and then figure out that he is seriously ill. My issue is not necessarily with the misdiagnosis, but with the seeming haste in getting this guy out of the military at what I understand is warp speed as far as paperwork goes.

Now, I am just a medical student, and don't have a lot of experience in the medical corps, but my reading on this site and other limited experience make me question whether this type of action may in fact be standard procedure. If a servicemember is seriously ill, why the propensity to separate them so quickly?

The "haste" is really dependent on the relative efficiency of the local command.

Different things add push to the process: need for the hospital bed, permanent nature of the disability and thus little reason to hold the member in active status, desires or requirements of the member and his family, availability of a potential receiving facility or rehabilitation program in the VA.
Usually people with permanently disabling disease are separated from their commands in order for the personnel system to be able to assign a replacement; this is particularly true for deploying units and usually takes place at the 30-day out of duty point.

 

[The White Coat Investor]

Why separate someone with viral meningitis? He's going to be back to work in a week and take motrin until then. Something isn't right here.

 

[orbitsurgMD]

Why separate someone with viral meningitis? He's going to be back to work in a week and take motrin until then. Something isn't right here.

Discharged in the sentence you are quoting meant "released from the hospital".

 

[DocArmy]

Discharged in the sentence you are quoting meant "released from the hospital".

Good eye. I misread the article.

Although, I have heard of people being medically separated for TBI's and other combat sustained injuries with a fair amount of haste. I guess that was the reason I read the article the way that I did.

Carry on.

 

[IgD]

I found myself looking up the difference between viral meningitis and encephalitis. We could learn something from hearing the details of the case the steps that let up to the adverse outcome.

 

[i want out]

I found myself looking up the difference between viral meningitis and encephalitis. We could learn something from hearing the details of the case the steps that let up to the adverse outcome.

This wasn't from an injury, but I saw a guy with a personality disorder get separated in less than 24 hours from the time that the command received the recomendation to the time he was walking down the brow without an ID card.

If your PSD folks have their stuff lined up and can work efficiently, they can make stuff happen so fast that your head will spin, but most days they are bogged down with the same .gov inertia that impedes all other progress.

i want out(of IRR)

 

[RVUKing]

I found myself looking up the difference between viral meningitis and encephalitis. We could learn something from hearing the details of the case the steps that let up to the adverse outcome.

Most likely this patient presented with a fever and a headache. A lumbar puncture was performed, but no CSF HSV PCR was ordered. IV acyclovir was probably not given empirically, either. The patient most likely developed hemorrhagic necrosis of one or both temporal lobes. If the necrosis had been severe enough, it could have led to uncal herniation and death.

An MRI of the brain probably was not ordered, either. Most likely a CT head was done which often looks normal in the early stages of encephalitis.

(Even if it had been viral meningits, HIV should have been looked into as well as it can cause meningitis on seroconversion.)

 

[RVUKing]

I just want to mention that this could have occurred at any civilian hospital. When I was an intern, one of the patients I admitted was a thirtysomething patient who went to a community hospital with a low grade fever, normal serum WBC, and a headache and was misdiagnosed as having a migraine. He actually had HSV encephalitis and had full resolution of his symptoms with IV acyclovir.

 

[RVUKing]

The most egregious example of malpractice I know of involved a spinal cord injury that was misdiagnosed at a top 20 medical center. The patient was a veteran in his 50's who was drinking with his buddies on a Friday night and without warning collapsed to the ground shortly after tilting his head back to get the last drop from his mug. He was taken by ambulance to the hospital where he had an alcohol level checked and was treated for alcohol intoxication. When he woke up the following morning, he complained to the nurse that he could barely move his arms or legs. He had a head CT done which was normal and then was placed in a wheelchair and discharged home with his family. His family decided to get a second opinion and took him to the VA hospital when I was on call. By then he was complaining of inability to urinate and had signs and symptoms of central cord syndrome. He had little to no use of his hands. I immediately placed a hard cervical collar, drained over 1 L of urine from his bladder, and sent him for a stat MRI c-spine which revealed severe compressive cervical myelopathy from a disc hernation at the C5-C6 level. I was in utter disbelief until the patient's family showed me the discharge papers from the other hospital.

 

[IgD]

The most egregious example of malpractice I know of involved a spinal cord injury that was misdiagnosed at a top 20 medical center. The patient was a veteran in his 50's who was drinking with his buddies on a Friday night and without warning collapsed to the ground shortly after tilting his head back to get the last drop from his mug. He was taken by ambulance to the hospital where he had an alcohol level checked and was treated for alcohol intoxication. When he woke up the following morning, he complained to the nurse that he could barely move his arms or legs...I was in utter disbelief until the patient's family showed me the discharge papers from the other hospital.

Not saying something wasn't missed but it's difficult to evaluate someone who is intoxicated or withdrawing especially when they are wanting to leave and suffer from chronic alcoholism.

 

[RVUKing]

Not saying something wasn't missed but it's difficult to evaluate someone who is intoxicated or withdrawing especially when they are wanting to leave and suffer from chronic alcoholism.

True. But the patient was apparently sober the following morning to say to the nurse that he could not move his limbs very well, especially his hands. He had weakness mostly in the upper limbs, distal worse than proximal, and 4/5 motor strength in the lower extremities but unable to stand. Central cord syndrome was simply not in their differential.

By the way, the patient and his family drove straight from the medical center to the VA hospital because they suspected something was seriously wrong neurologically. They were right.