- Joined
- Aug 21, 2007
- Messages
- 7,863
- Reaction score
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I just got a letter from the Board of Health. What follows is a summary:
******************************************************************************
-- Dear DR. RUSTEDFOX
Do you remember that med-mal lawsuit in 2020? You know; that one where BOTH the patient AND her husband told you that she WASN'T allergic to IV contrast dye despite what the chart said, so you totally did the right thing and double-checked with them before you gave it to her and then she died two weeks later of a completely unrelated cause?
That one where the patient and her husband said the same thing to the nursing and radiology staff, before they carried out the CT abdomen/pelvis that you ordered?
That one where you could totally prove that it wasn't the contrast dye that you gave, but rather the antibiotics that she was taking for like, weeks?
The one where the patient’s husband changed his mind after her unfortunate demise and said something like: "Well, maybe she WAS allergic to the contrast dye after all? Yeah! That - that HAS to be it, because old people that collect diseases like our grandkids collect Pokémon cards don't just die, right? Right?! SOMEONE'S GOTTA PAYY!"
Yeah; THAT one. Pretty radical, huh?
Yeah, so like - me and the boys down here at the board got around to it. We had a good long look. Guess what? Turns out we think that you were right all along. Damn, those people were dumb. Great move by calculating that ALDEN score to prove that it wasn't the contrast dye that caused the patient to develop Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Not many people would have thought of doing that. Strong work - you REALLY must have paid attention in medical school. Too bad you got sued and had to settle the case anyways. Lolz. Have a good shift, bro.
- Signed,
The Mouthbreathers at the Citadel of Ricks.
*****************************************************************************
Here's my fictitious response:
- Dear Mouthbreathers,
Hey bros. [BURRRP!] Yeah; I'm really glad you finally got around to that. Like, I really don’t wanna say this buuut… I told you so. Can you guys un-sue me and give me back all the time, money, and stress that I spent on it? You know, like, erase it from my record and all? 'Cause that would be real cool. It would be like, the right thing to do on your part.
No? That sucks, bro. Cause it would have been really compelling evidence to have at the time, you know.... when the STATE BOARD OF WHATEVER says that you're smarter than all the expert witnesses that the prosecutor paid-off to sell you down the river, it's generally a good thing to know. Real game-changer, there... Probably would have changed the outcome ‘n stuff.
Did I mention that this whole thing was a rather large contributor to me totally burning out of clinical medicine, spiraling into depression, consuming a terrific number of alcohol-containing beverages (go big or go home, amirite?), having the SNRI/benzodiazepine combo-meal prescribed to me totally backfire, considering walking away from society like “Kwai-Chang Caine” style, and then briefly considering bridge jumping as a one-time extreme sport? Sure, I had other things going on in my life at the time that really sucked (that’s on me), but this one was a biggie. Could’ve really used your help awhile back, amigos.
Anyways, I feel better now after having gotten this letter waaaay later than would have been helpful. I'm gonna go ride my sweet new mountain bike. Shred you later, posers.
-- Eff you guys for real,
Rick Sanchez C-137
P.S. - It took you two YEARS and a whole BOARD of physicians to figure out what I did by myself in like, two DAYS and a few six-packs of Michelob Ultra. So, DOUBLE eff you guys [makes gesture with two middle fingers extended while moving them up-and-down in a vertical dimension immediately next to one another].
******************************************************************************
[Record scratch, freeze-frame]
Yep. That’s me. You’re probably wondering how I got here.
[VHS-tape rewind montage that lasts just long enough for your individual attention-span]
It was a day like any other. A shift like any other. A parade of senior citizens here in the United States Capitol Of Senior Citizens. EMS brings in a 79-year-old female. Syncope after lower GI bleeding; passed out on the commode, fell forward, bonked head. EMS says the volume of blood was pretty big, which we all know can mean anything.
Great historian, this one. She takes all of the medicines. All of them: Lispinopril. Propanol. Pregnasone. Hydrofoil. Metalpronoun. “That one for the thyroid”. Waterpill. Asspirin. Whatever. She can’t pronounce her name correctly, let alone know what meds she takes. Thank Christ for the medical record. She’s only been in and out of every hospital system in three counties two dozen times in the past two years. Bowel resection. Coronary artery disease; stent-and-CABG. Breast cancer. Gallbladder. Pacemaker in. Endocarditis. Pacemaker out. Wound site infection. Presently taking IV Cefokillitall and Gorillamycin daily for about 3-4 weeks now for the endocarditis and pacemaker site infection thru her PICC. Now here, with me, today, for LGIB resulting in syncope and headbonk.
Abdominal exam is benign, but I’m pushing thru a foot+ of adiposity. ‘Murica.
Last hemoglobin was 11.8 about two weeks ago. Today’s is 9.2 Hmm. That’s a big enough drop to catch my attention. Type and screen. Lock and load. CT abdomen/pelvis with contrast. Before anyone reflexively says: “Why did you even order the CT?” – both you and I know that IM is going to doc-block me if I don’t get it, so eff off.
Allergies listed:
Iodine (lol). IV dye. Shellfish. Red dye. Codeine. Penicillin.
I walk back in the exam room. This time, her husband is in the room, as is the nurse.
“Hey, we really need to see if we can identify where it is that you’re bleeding from. To do that, we need to do a CAT scan with contrast dye. On your chart, there’s an allergy listed to contrast dye, bu-“
“No. Its not contrast dye. Its red dye. I’ve had contrast before”, she interrupted.
I’m sorry… say that again?
“Yes. It’s RED dye.”
You mean, like, food coloring? Red-40? That kind of thing?
“It’s RED dye.” [husband nods in agreement, repeats that its red dye]
Me: Okay, thank you. We’re going to get that CAT scan and see if we can find the bleed.
Me, to myself: “Okay, I’m not sure what kind of fugging weirdos you guys are and I don’t care.”
I went away, clicked the button to order the CT abd/pelvis w/contrast. Barbara (which is like “Karen” for the 75+ crowd) goes to radiology. Rad tech has the same red-dye-green-light discussion with the patient. Patient signs consent. Patient gets CT scan. Patient returns from radiology. Nothing happens. CT is boring because they are. Patient gets admitted.
[Freeze-frame]
Me, looking at camera, not frozen and walking cool-ly around the scene while others remain frozen in place and in awkward positions:
“You guys probably want me to move this along at this point. I’ve been here before, so let’s make it quick. A day or so later, the patient developed a rash. That rash turned into Stevens-Johnson Syndrome. That Stevens-Johnson Syndrome turned into Toxic Epidermal Necrolysis. That Toxic Epidermal Necrolysis turned into a transfer to a burn unit for all the useless things like steroids, fluids, etc. before the patient succumbed to sepsis and multisystem organ failure. A few weeks later, I got the notice of intent.”
The allegation: This woman had an allergy to IV contrast dye listed in her chart. You gave her IV contrast dye. You didn’t pre-medicate her. A rash is an allergic reaction. She developed SJS/TEN and died. You killed her.
The defense: I reviewed the allergy with patient and husband, who both denied it to myself and multiple others; insisting strangely that the allergy was to “red dye”. If she was actually allergic; its not my fault that the patient was so ostriched. She signed the consent. Besides, SJS/TEN isn’t an “allergic reaction”, so knock that nonsense off right now. Pre-medication does nothing for moderate or severe reactions as per the radiology manual; besides that – she’s chronically on megadose prednisone for her COPD and has had loads of IV dye in the past for her collage of cardiovascular studies; often without premedicaiton. It was the Gorillamycin that likely caused the SJS/TEN, not the angelfart of IV dye that I ordered. Besides that, I needed the study; I wasn’t going to wait around for her to have another huge bleed and syncope before I acted.
More allegations: Her abdominal exam was benign. You didn’t need the CT at all.
More defense: She’s too fat for any reliable abdominal exam because ‘Murica. She’s on megadose prednisone, which even more totally nerfs the abdominal exam. Ask me how I know; I’ve made that mistake before and missed a perforated viscus that was later caught on CT when I felt discretion was the better part of valor.
Okay, let’s rumble. Deposition time comes, and I’m cooler than the other side of the pillow. I bob, I weave, we circle. I’m waiting for my opening. Opposing attorney is wearing a fishing shirt because lulz. I’m in suit-and-tie. I’m sorry to interrupt your critically important fishing schedule with my defense, you fat piece of trash. Enjoy heart disease, fugger. NOBODY is that buttery and doesn't have coronaries that hate them.
Eventually, he makes his mistake – the one I’ve been waiting for.
“So, you agree that rashes are a defining feature of allergic reactions, and that this rash began a chain of events that led to the patient’s death?”
“No, I don’t – you’re making a critical error here. Yes; rashes are a defining feature of allergic reactions… but this rash is different. This is the rash of SJS/TEN, a phenomenon which is so extraordinarily rare so as to statistically be less likely than being struck by lightning. It's not an "allergic reaction". It typically happens after the patient has been taking a culprit drug with certain qualities and characteristics.” [YES, I ACTUALLY SAID THIS AND EVERYTHING THAT FOLLOWS.]
“What are those qualities and characteristics?”
“Well, it can happen with any drug, at any time – but most overwhelmingly commonly - the culprit drug is an antibiotic, taken for between 3 and 6 weeks, with a long half-life, a high molecular weight, and certain specific molecular structures.”
“So, do you have an alternative *culprit drug* that resulted in this patient’s death, if it wasn’t the contrast dye that YOU ordered, Dr. RustedFox?” (I could tell that he was really leaning into this punch. Good. He whiffed.)
“I do.” - So Laconic. I’m such a smug ass.
“And what might that drug be, Dr. RustedFox?”
“The Gorillamycin that the patient was prescribed for her ongoing infection. It’s an antibiotic, that the patient was taking for almost precisely 3 weeks, with a long half life, a high molecular weight, and certain specific molecular structure – in this case; a macrolide ring and several other features. When we try to identify a culprit drug, we calculate what is called the ALDEN score (you guys can google this). When you do this; you can see that the categorical outcome is that the IV contrast dye is classified as “unlikely” and the Gorillamycin is classified as “highly likely”.”
Boom! There it was; the knockout punch. Cue the slow-motion shot of the bareknuckle boxer in the Guy Ritchie movie taking a right hook across the mouth, head snapping backward, blank look in the eyes, mouth snarled, blood and spit spraying in all directions before coming off his feet and landing with a wet thud on the canvas. *DING-DING-DINNG!*
“Lets take a break.”
We break. Attorney says to me: “Yep. It’s clear to me that he didn’t see that coming at all. Strong work, Little Mac. Strong. Work.” He might as well sprayed the water bottle into my open mouth and wrapped me in a towel.
More experts are deposed. The Greek God of Immunology himself descends from Mount Cytokine to defend me. Chair of the Immunology department at Ivory Tower University Medical Center, published in all the journals, winner of all the awards, King of the Britons, Defeater of the Saxons, Sovereign of All England.
“Yeah; the kid is right.”
Pre-trial summaries are written. The attorney called me “more than capable of performing in excellent fashion under pressure”. Really, homes? You don’t say. It’s like, kind of what we do in EM.
---
Months go by. One day, I get a letter from the attorney telling me to clear my schedule next month; we’re going to trial. Cancel that trip that you had planned to Arizona to see the big rocks on your big birthday. Wait, what?! No other news? Th’hell, man?!
Yeah, so it seems that they want to expedite the trial, because the only claimant (the patient’s husband) is 87, on dialysis, in extraordinarily poor health, and could die at any hot minute if he breathes too hard or misses dialysis. He dies, and the case dies along with him. Nobody collects, including the attorneys. They wanna go.
They had one more witness to depose. Dr. Moviestar, Chair of Whatever at Old University Medical School. Apparently, this guy was, as per the summary: handsome, likeable, and straight out of central casting – a doctor straight from a primetime drama. Its not that he had any scathing criticisms of my care, other than “the scan shouldn’t have been done at all, and emergent endoscopy should have been done instead”.
Now, you and I know that there’s no way that GI is coming in to do this scope at 12:15 AM on a Saturday morning. Not in my shop. Maybe your in-house GI fellow will up at Ivy League Medical Center because he’s chained up in the call room. That’s cool that he’s into BDSM; but that’s not where I work. Get a grip. He also argued that I should have thoroughly reviewed the hundreds of pages of records (mostly from other health systems and not available to me at the time) to find the instance where the patient developed (gasp!) an uneventful rash after IV dye that resolved without incident and in response to Solu-Medrol, and that this would have changed the medical decision making to delay the emergent scan and pre-medicate the patient.
Now, this is getting complex. The insurance company fully admits that “this isn’t about the medicine; we’re concerned that Dr. Ryan Gosling will confuse a jury of ostriches into agreeing with him, because he’s pretty" and my defense of: "she was too fat for me to rely on abdominal exam and is taking megadoses of roids" wasn't exactly endearing.
Really, homey? I’m not so bad looking myself. They didn’t want to hear it.
Case settled for a quarter million.
So why was the Citadel of Ricks involved? Early on, plaintiff’s counsel filed a complaint against me to the Citadel, in an effort at getting a “free medical quality case review”. If the Citadel decided that I was an ostrich, then it’s a layup for them. If not, well – then they’ve got a problem moving the case forward at all.
So, thanks for dragging your feet on that one, Citadel of Ricks. Thanks a lot.
******************************************************************************
-- Dear DR. RUSTEDFOX
Do you remember that med-mal lawsuit in 2020? You know; that one where BOTH the patient AND her husband told you that she WASN'T allergic to IV contrast dye despite what the chart said, so you totally did the right thing and double-checked with them before you gave it to her and then she died two weeks later of a completely unrelated cause?
That one where the patient and her husband said the same thing to the nursing and radiology staff, before they carried out the CT abdomen/pelvis that you ordered?
That one where you could totally prove that it wasn't the contrast dye that you gave, but rather the antibiotics that she was taking for like, weeks?
The one where the patient’s husband changed his mind after her unfortunate demise and said something like: "Well, maybe she WAS allergic to the contrast dye after all? Yeah! That - that HAS to be it, because old people that collect diseases like our grandkids collect Pokémon cards don't just die, right? Right?! SOMEONE'S GOTTA PAYY!"
Yeah; THAT one. Pretty radical, huh?
Yeah, so like - me and the boys down here at the board got around to it. We had a good long look. Guess what? Turns out we think that you were right all along. Damn, those people were dumb. Great move by calculating that ALDEN score to prove that it wasn't the contrast dye that caused the patient to develop Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Not many people would have thought of doing that. Strong work - you REALLY must have paid attention in medical school. Too bad you got sued and had to settle the case anyways. Lolz. Have a good shift, bro.
- Signed,
The Mouthbreathers at the Citadel of Ricks.
*****************************************************************************
Here's my fictitious response:
- Dear Mouthbreathers,
Hey bros. [BURRRP!] Yeah; I'm really glad you finally got around to that. Like, I really don’t wanna say this buuut… I told you so. Can you guys un-sue me and give me back all the time, money, and stress that I spent on it? You know, like, erase it from my record and all? 'Cause that would be real cool. It would be like, the right thing to do on your part.
No? That sucks, bro. Cause it would have been really compelling evidence to have at the time, you know.... when the STATE BOARD OF WHATEVER says that you're smarter than all the expert witnesses that the prosecutor paid-off to sell you down the river, it's generally a good thing to know. Real game-changer, there... Probably would have changed the outcome ‘n stuff.
Did I mention that this whole thing was a rather large contributor to me totally burning out of clinical medicine, spiraling into depression, consuming a terrific number of alcohol-containing beverages (go big or go home, amirite?), having the SNRI/benzodiazepine combo-meal prescribed to me totally backfire, considering walking away from society like “Kwai-Chang Caine” style, and then briefly considering bridge jumping as a one-time extreme sport? Sure, I had other things going on in my life at the time that really sucked (that’s on me), but this one was a biggie. Could’ve really used your help awhile back, amigos.
Anyways, I feel better now after having gotten this letter waaaay later than would have been helpful. I'm gonna go ride my sweet new mountain bike. Shred you later, posers.
-- Eff you guys for real,
Rick Sanchez C-137
P.S. - It took you two YEARS and a whole BOARD of physicians to figure out what I did by myself in like, two DAYS and a few six-packs of Michelob Ultra. So, DOUBLE eff you guys [makes gesture with two middle fingers extended while moving them up-and-down in a vertical dimension immediately next to one another].
******************************************************************************
[Record scratch, freeze-frame]
Yep. That’s me. You’re probably wondering how I got here.
[VHS-tape rewind montage that lasts just long enough for your individual attention-span]
It was a day like any other. A shift like any other. A parade of senior citizens here in the United States Capitol Of Senior Citizens. EMS brings in a 79-year-old female. Syncope after lower GI bleeding; passed out on the commode, fell forward, bonked head. EMS says the volume of blood was pretty big, which we all know can mean anything.
Great historian, this one. She takes all of the medicines. All of them: Lispinopril. Propanol. Pregnasone. Hydrofoil. Metalpronoun. “That one for the thyroid”. Waterpill. Asspirin. Whatever. She can’t pronounce her name correctly, let alone know what meds she takes. Thank Christ for the medical record. She’s only been in and out of every hospital system in three counties two dozen times in the past two years. Bowel resection. Coronary artery disease; stent-and-CABG. Breast cancer. Gallbladder. Pacemaker in. Endocarditis. Pacemaker out. Wound site infection. Presently taking IV Cefokillitall and Gorillamycin daily for about 3-4 weeks now for the endocarditis and pacemaker site infection thru her PICC. Now here, with me, today, for LGIB resulting in syncope and headbonk.
Abdominal exam is benign, but I’m pushing thru a foot+ of adiposity. ‘Murica.
Last hemoglobin was 11.8 about two weeks ago. Today’s is 9.2 Hmm. That’s a big enough drop to catch my attention. Type and screen. Lock and load. CT abdomen/pelvis with contrast. Before anyone reflexively says: “Why did you even order the CT?” – both you and I know that IM is going to doc-block me if I don’t get it, so eff off.
Allergies listed:
Iodine (lol). IV dye. Shellfish. Red dye. Codeine. Penicillin.
I walk back in the exam room. This time, her husband is in the room, as is the nurse.
“Hey, we really need to see if we can identify where it is that you’re bleeding from. To do that, we need to do a CAT scan with contrast dye. On your chart, there’s an allergy listed to contrast dye, bu-“
“No. Its not contrast dye. Its red dye. I’ve had contrast before”, she interrupted.
I’m sorry… say that again?
“Yes. It’s RED dye.”
You mean, like, food coloring? Red-40? That kind of thing?
“It’s RED dye.” [husband nods in agreement, repeats that its red dye]
Me: Okay, thank you. We’re going to get that CAT scan and see if we can find the bleed.
Me, to myself: “Okay, I’m not sure what kind of fugging weirdos you guys are and I don’t care.”
I went away, clicked the button to order the CT abd/pelvis w/contrast. Barbara (which is like “Karen” for the 75+ crowd) goes to radiology. Rad tech has the same red-dye-green-light discussion with the patient. Patient signs consent. Patient gets CT scan. Patient returns from radiology. Nothing happens. CT is boring because they are. Patient gets admitted.
[Freeze-frame]
Me, looking at camera, not frozen and walking cool-ly around the scene while others remain frozen in place and in awkward positions:
“You guys probably want me to move this along at this point. I’ve been here before, so let’s make it quick. A day or so later, the patient developed a rash. That rash turned into Stevens-Johnson Syndrome. That Stevens-Johnson Syndrome turned into Toxic Epidermal Necrolysis. That Toxic Epidermal Necrolysis turned into a transfer to a burn unit for all the useless things like steroids, fluids, etc. before the patient succumbed to sepsis and multisystem organ failure. A few weeks later, I got the notice of intent.”
The allegation: This woman had an allergy to IV contrast dye listed in her chart. You gave her IV contrast dye. You didn’t pre-medicate her. A rash is an allergic reaction. She developed SJS/TEN and died. You killed her.
The defense: I reviewed the allergy with patient and husband, who both denied it to myself and multiple others; insisting strangely that the allergy was to “red dye”. If she was actually allergic; its not my fault that the patient was so ostriched. She signed the consent. Besides, SJS/TEN isn’t an “allergic reaction”, so knock that nonsense off right now. Pre-medication does nothing for moderate or severe reactions as per the radiology manual; besides that – she’s chronically on megadose prednisone for her COPD and has had loads of IV dye in the past for her collage of cardiovascular studies; often without premedicaiton. It was the Gorillamycin that likely caused the SJS/TEN, not the angelfart of IV dye that I ordered. Besides that, I needed the study; I wasn’t going to wait around for her to have another huge bleed and syncope before I acted.
More allegations: Her abdominal exam was benign. You didn’t need the CT at all.
More defense: She’s too fat for any reliable abdominal exam because ‘Murica. She’s on megadose prednisone, which even more totally nerfs the abdominal exam. Ask me how I know; I’ve made that mistake before and missed a perforated viscus that was later caught on CT when I felt discretion was the better part of valor.
Okay, let’s rumble. Deposition time comes, and I’m cooler than the other side of the pillow. I bob, I weave, we circle. I’m waiting for my opening. Opposing attorney is wearing a fishing shirt because lulz. I’m in suit-and-tie. I’m sorry to interrupt your critically important fishing schedule with my defense, you fat piece of trash. Enjoy heart disease, fugger. NOBODY is that buttery and doesn't have coronaries that hate them.
Eventually, he makes his mistake – the one I’ve been waiting for.
“So, you agree that rashes are a defining feature of allergic reactions, and that this rash began a chain of events that led to the patient’s death?”
“No, I don’t – you’re making a critical error here. Yes; rashes are a defining feature of allergic reactions… but this rash is different. This is the rash of SJS/TEN, a phenomenon which is so extraordinarily rare so as to statistically be less likely than being struck by lightning. It's not an "allergic reaction". It typically happens after the patient has been taking a culprit drug with certain qualities and characteristics.” [YES, I ACTUALLY SAID THIS AND EVERYTHING THAT FOLLOWS.]
“What are those qualities and characteristics?”
“Well, it can happen with any drug, at any time – but most overwhelmingly commonly - the culprit drug is an antibiotic, taken for between 3 and 6 weeks, with a long half-life, a high molecular weight, and certain specific molecular structures.”
“So, do you have an alternative *culprit drug* that resulted in this patient’s death, if it wasn’t the contrast dye that YOU ordered, Dr. RustedFox?” (I could tell that he was really leaning into this punch. Good. He whiffed.)
“I do.” - So Laconic. I’m such a smug ass.
“And what might that drug be, Dr. RustedFox?”
“The Gorillamycin that the patient was prescribed for her ongoing infection. It’s an antibiotic, that the patient was taking for almost precisely 3 weeks, with a long half life, a high molecular weight, and certain specific molecular structure – in this case; a macrolide ring and several other features. When we try to identify a culprit drug, we calculate what is called the ALDEN score (you guys can google this). When you do this; you can see that the categorical outcome is that the IV contrast dye is classified as “unlikely” and the Gorillamycin is classified as “highly likely”.”
Boom! There it was; the knockout punch. Cue the slow-motion shot of the bareknuckle boxer in the Guy Ritchie movie taking a right hook across the mouth, head snapping backward, blank look in the eyes, mouth snarled, blood and spit spraying in all directions before coming off his feet and landing with a wet thud on the canvas. *DING-DING-DINNG!*
“Lets take a break.”
We break. Attorney says to me: “Yep. It’s clear to me that he didn’t see that coming at all. Strong work, Little Mac. Strong. Work.” He might as well sprayed the water bottle into my open mouth and wrapped me in a towel.
More experts are deposed. The Greek God of Immunology himself descends from Mount Cytokine to defend me. Chair of the Immunology department at Ivory Tower University Medical Center, published in all the journals, winner of all the awards, King of the Britons, Defeater of the Saxons, Sovereign of All England.
“Yeah; the kid is right.”
Pre-trial summaries are written. The attorney called me “more than capable of performing in excellent fashion under pressure”. Really, homes? You don’t say. It’s like, kind of what we do in EM.
---
Months go by. One day, I get a letter from the attorney telling me to clear my schedule next month; we’re going to trial. Cancel that trip that you had planned to Arizona to see the big rocks on your big birthday. Wait, what?! No other news? Th’hell, man?!
Yeah, so it seems that they want to expedite the trial, because the only claimant (the patient’s husband) is 87, on dialysis, in extraordinarily poor health, and could die at any hot minute if he breathes too hard or misses dialysis. He dies, and the case dies along with him. Nobody collects, including the attorneys. They wanna go.
They had one more witness to depose. Dr. Moviestar, Chair of Whatever at Old University Medical School. Apparently, this guy was, as per the summary: handsome, likeable, and straight out of central casting – a doctor straight from a primetime drama. Its not that he had any scathing criticisms of my care, other than “the scan shouldn’t have been done at all, and emergent endoscopy should have been done instead”.
Now, you and I know that there’s no way that GI is coming in to do this scope at 12:15 AM on a Saturday morning. Not in my shop. Maybe your in-house GI fellow will up at Ivy League Medical Center because he’s chained up in the call room. That’s cool that he’s into BDSM; but that’s not where I work. Get a grip. He also argued that I should have thoroughly reviewed the hundreds of pages of records (mostly from other health systems and not available to me at the time) to find the instance where the patient developed (gasp!) an uneventful rash after IV dye that resolved without incident and in response to Solu-Medrol, and that this would have changed the medical decision making to delay the emergent scan and pre-medicate the patient.
Now, this is getting complex. The insurance company fully admits that “this isn’t about the medicine; we’re concerned that Dr. Ryan Gosling will confuse a jury of ostriches into agreeing with him, because he’s pretty" and my defense of: "she was too fat for me to rely on abdominal exam and is taking megadoses of roids" wasn't exactly endearing.
Really, homey? I’m not so bad looking myself. They didn’t want to hear it.
Case settled for a quarter million.
So why was the Citadel of Ricks involved? Early on, plaintiff’s counsel filed a complaint against me to the Citadel, in an effort at getting a “free medical quality case review”. If the Citadel decided that I was an ostrich, then it’s a layup for them. If not, well – then they’ve got a problem moving the case forward at all.
So, thanks for dragging your feet on that one, Citadel of Ricks. Thanks a lot.
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