So state caps on malpractice awards are…useless? ER doc lost in state with $400K cap, $13.5M given to patient

[wamcp]

Idaho awards second-largest medical malpractice settlement after a patient has a stroke in the ER | MDLinx

An Idaho man was awarded $13.5 million after a local hospital failed to diagnose his stroke for over 12 hours.

www.mdlinx.com

Did a search and didn’t see this posted here but this seems…horrific. Like what did the ER doc actually do wrong…?

“A jury in Ada County, Idaho, has awarded $13.5 million, the second-largest medical malpractice award in the state’s history, to a stroke survivor in a case against a physician from Emergency Medicine of Idaho and the group itself.

The case revolves around an emergency room visit in 2016 when Carl B. Stiefel’s wife called an ambulance after he began experiencing a severe headache, nausea, and confusion. Stiefel arrived in the ER at 4:11 a.m. and was seen by a physician 11 minutes later. A CT was ordered, and the results did not reveal any signs of an intracranial concern. Stiefel was admitted to the hospital with a diagnosis of “benign positional vertigo.” His symptoms were not improving, and an MRI was considered.

However, the suit against Emergency Medicine of Idaho alleges that it then took three hours for Stiefel to be moved to a room for observation.”

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[bravotwozero]

Will get knocked down on appeal

 

[wamcp]

Will get knocked down on appeal

Even so why did the ER doc lose? There was nothing really done wrong? Appropriate testing was ordered, how can patient blame the ER doc for MRI machine to be too busy?

 

[ScepticSkeksis]

Even so why did the ER doc lose? There was nothing really done wrong? Appropriate testing was ordered, how can patient blame the ER doc for MRI machine to be too busy?

Lawyers can sue a ham sandwich, and a jury of idiots will convict.

 

[Mount Asclepius]

Sounds like Idaho’s cap is more of a soft cap.

Also very possible it could be lowered on appeal.

Liberally consider CTA head/neck imaging.

Don’t diagnose BPPV. Include in differential, but put diagnosis as vertigo.

Also looks like headache was one of the main presenting symptoms, which also isn’t entirely consistent with BPPV.

 

[HemeOncHopeful19]

I am not a lawyer.

A) Idaho appears to have a cap on “non-economic damages” aka “pain and suffering” but doesn’t have a cap on economic damages so my understanding is the lawyer will add up whatever ridiculous self pay costs for lifelong medical care to argue the “damages”

B) Jury can always award over the cap and then the judge later reduces the award to the capped amount which of course doesn’t make headlines

 

[Dr Mantis Toboggan]

I am not a lawyer.

A) Idaho appears to have a cap on “non-economic damages” aka “pain and suffering” but doesn’t have a cap on economic damages so my understanding is the lawyer will add up whatever ridiculous self pay costs for lifelong medical care to argue the “damages”

B) Jury can always award over the cap and then the judge later reduces the award to the capped amount which of course doesn’t make headlines

Also it seems they regarded this care as “willful or reckless”. Doesn’t seem that it was either at all but usually in such states all you need is one expert willing to testify so and it’s game on for a jury trial. Doesn’t seem like judges can or will just throw cases out which don’t meet the standard, they will want a jury to decide that from what I know.

 

[Birdstrike]

These types of cases have been happening for decades. Meaningful changes don't happen until enough doctors abandon judicial hellhole jurisdictions in such numbers that it creates a crisis.

There was a time when so many OB/Gyns and neurosurgeons left certain counties and cities that there were none left to sue. Many people died because of it. Plaintiff's attorneys are happy to sue the Gold Goose until it's extinct. They care nothing of the consequences of their actions.

 

[Brigade4Radiant]

Sounds like Idaho’s cap is more of a soft cap.

Also very possible it could be lowered on appeal.

Liberally consider CTA head/neck imaging.

Don’t diagnose BPPV. Include in differential, but put diagnosis as vertigo.

Also looks like headache was one of the main presenting symptoms, which also isn’t entirely consistent with BPPV.

He was stil treated as a stroke and admitted he had a torn artery 3 hours is often the time one will stay in the ER

He wasn’t discharged this still doesn’t meet willful or reckless

 

[Mount Asclepius]

He was stil treated as a stroke and admitted he had a torn artery 3 hours is often the time one will stay in the ER

He wasn’t discharged this still doesn’t meet willful or reckless

I don’t have access to the details, but appears to be a missed vertebral artery dissection and stroke with a delayed diagnosis.

Stroke activation? CTA head/neck performed? TNK/tPA considered? Neuro consulted?

Seems like they just obtained a CT head, which was negative (cue every CT head radiology read that notes CT is insensitive for acute ischemic changes). Then errantly called it BPPV.

I’m not arguing the lawsuit has complete merit, but I can see how it had traction.

 

[Dr Mantis Toboggan]

I don’t have access to the details, but appears to be a missed vertebral artery dissection and stroke with a delayed diagnosis.

Stroke activation? CTA head/neck performed? TNK/tPA considered? Neuro consulted?

Seems like they just obtained a CT head, which was negative (cue every CT head radiology read that notes CT is insensitive for acute ischemic changes). Then errantly called it BPPV.

I’m not arguing the lawsuit has complete merit, but I can see how it had traction.

I hate vertigo within the thrombolytic window.

 

[lymphocyte]

Even so why did the ER doc lose? There was nothing really done wrong? Appropriate testing was ordered, how can patient blame the ER doc for MRI machine to be too busy?

The details are not great, and basically all the things you shouldn't do with acute vertigo. An MRI was not needed, just a good history and exam. I'm sure the more you dig, the worse the story gets.

"Stiefel’s nausea improved in the emergency room, but he remained 'too dizzy to walk,' the lawsuit said, so the first doctor who examined him decided he should be admitted to the hospital for 'benign positional vertigo,' the lawsuit said.

Physicians including the first doctor who examined him decided Stiefel might also need an MRI — which offers a more detailed look inside a body’s tissue — if his condition failed to improve as the day went on.

It took at least three hours for Stiefel to be transferred from the emergency room to a hospital bed where he could be observed, according to the lawsuit. By then, another health care provider found him to be 'delirious without meaningful interaction,' the lawsuit said. It took another four to five hours for Stiefel to be seen by another doctor, the lawsuit said."

He had a stroke and sued for medical malpractice. A jury awarded millions — rare in Idaho. • Idaho Capital Sun

A jury issued a multimillion-dollar verdict in a medical malpractice lawsuit in Idaho, where the law caps damages for most med-mal cases.

idahocapitalsun.com

 

[AlmostAnMD]

It took at least three hours for Stiefel to be transferred from the emergency room to a hospital bed where he could be observed, according to the lawsuit.

Three hours to transfer from ed to inpatient bed

Those are rookie numbers

*insert relevant gif*

 

[Tenk]

Three hours to transfer from ed to inpatient bed

Those are rookie numbers

*insert relevant gif*

I got you fam.

 

[Rendar5]

Even so why did the ER doc lose? There was nothing really done wrong? Appropriate testing was ordered, how can patient blame the ER doc for MRI machine to be too busy?

it’s actually not that hard to rip apart a case and make a doc look incompetent. HINTS exam wasn’t done, peripheral and truncal ataxia not documented, diagnosing a headache presentation as a benign disease?

In the last 15 cases I reviewed for defense attorneys, only two met standard of care 100% no matter how you read the chart. every other one could be interpreted in various ways and picked apart by a plaintiff attorney

 

[AlmostAnMD]

it’s actually not that hard to rip apart a case and make a doc look incompetent. HINTS exam wasn’t done, peripheral and truncal ataxia not documented, diagnosing a headache presentation as a benign disease?

In the last 15 cases I reviewed for defense attorneys, only two met standard of care 100% no matter how you read the chart. every other one could be interpreted in various ways and picked apart by a plaintiff attorney

This is why I've honestly just given up on defensive charting. I can either spend 3 extra hours a day defensively charting on every patient I see in a department with dangerously high volume and bad staffing or just do the best I can and keep documentation to bare minimum and leave on time. If someone is gonna sue, they're gonna sue. Like you, someone will find some minutiae that isn't succinctly documented and tank my whole argument.

 

[TooMuchResearch]

I hate vertigo within the thrombolytic window.

I don't. Unless it's pretty obvious peripheral vertigo, call stroke code and neurology is The Decider.

 

[cyanide12345678]

I hate vertigo within the thrombolytic window.

Usually you can argue that their nih is low enough to not to warrant tpa.

Though i do CTA a bunch of these especially when older to look for vertebral/basilar occlusion/stenosis/dissection.

But my rural ERs aren’t that busy, so doing an extra CT doesn’t usually kill work flow.

 

[ScepticSkeksis]

This is why I've honestly just given up on defensive charting. I can either spend 3 extra hours a day defensively charting on every patient I see in a department with dangerously high volume and bad staffing or just do the best I can and keep documentation to bare minimum and leave on time. If someone is gonna sue, they're gonna sue. Like you, someone will find some minutiae that isn't succinctly documented and tank my whole argument.

Agree completely. I see some absolutely insane charts with long, novel-like H&P combined with detailed minute-by-minute description of the ED course. I see people who do this get way behind on patients, then stay routinely 1-2 hours after their shift. Not for me. It's easier to get sued, than to deal with the stress/anxiety of defensive charting and burnout from staying late all the time.

 

[ScepticSkeksis]

I don't. Unless it's pretty obvious peripheral vertigo, call stroke code and neurology is The Decider.

Neurology wants Tpa for everything. It's like they aren't real people, just AI programs spitting out a canned answer.

 

[wholeheartedly]

By then, another health care provider found him to be 'delirious without meaningful interaction,' the lawsuit said. It took another four to five hours for Stiefel to be seen by another doctor, the lawsuit said."

He had a stroke and sued for medical malpractice. A jury awarded millions — rare in Idaho. • Idaho Capital Sun

A jury issued a multimillion-dollar verdict in a medical malpractice lawsuit in Idaho, where the law caps damages for most med-mal cases.

idahocapitalsun.com

This part would seem be the major issue.

 

[TooMuchResearch]

Neurology wants Tpa for everything. It's like they aren't real people, just AI programs spitting out a canned answer.

Okay. They want to be involved, I involve them, they make the decision.

 

[ScepticSkeksis]

Okay. They want to be involved, I involve them, they make the decision.

Exactly correct.