No Documentation of Communication with Other Providers? ED’s Defense is Hindered
Charts lack any evidence others were informed
A patient who presented to the emergency department (ED) complaining of nausea and right upper quadrant pain radiating to the epigastric area, difficulty walking and climbing stairs, and difficulty breathing, was presumed to be suffering from cholecystitis and prepared for a cholecystectomy.
In the interim, the emergency physician (EP) had ordered liver function tests (LFTs) and a full cardiac panel. The cardiac panel showed an elevated troponin, and subsequent tests performed the next morning showed normal LFTs, including normal alkaline phosphatase.
"Nevertheless, the care team proceeded with the cholecystectomy. Unfortunately, the patient died during the surgery," says Angela L. Carr, JD, a partner in the Providence, RI, office of Barton Gilman.
The plaintiff alleged that the EP and other treating physicians failed to view the elevated troponin level as a red flag that the patient’s symptoms had a cardiac etiology.
"The plaintiff placed a significant focus on the fact that the emergency department physician never made any notation in the medical records of having reviewed the results of either cardiac panel," says Carr.
Accordingly, the plaintiff argued that had the physicians reviewed the various test results, they would have ordered a full cardiac evaluation, which would have shown that the patient was not an appropriate candidate for surgery and/or that the patient’s symptoms were cardiac in nature. "The defendants were forced to settle," says Carr.
Carr has seen several other claims against EPs with similar fact patterns, involving failure to communicate with other providers. "These cases frequently involve miscommunications that occur as a result of critical values not being reported to all physicians caring for a particular patient," she says.
Failure to Document
Matt Mitcham, senior vice president of claims for MagMutual, an Atlanta-based provider of medical professional liability insurance, has seen several claims against EPs alleging failure to communicate with other EPs, admitting physicians, or other subsequent treating physicians.
These claims typically allege that the EP’s failure to communicate with other treating physicians led to an improper diagnosis and a breach of the standard of care, resulting in damage to the patient.
"We see cases all the time where a plaintiff attorney is suing an admitting physician for not coming in and seeing the patient right away," says Mitcham. If the plaintiff attorney alleges the patient’s bad outcome was due to lack of definitive treatment, the other treating physician typically points a finger at the EP. "This sets up an immediate conflict," he says. "If the EP isn’t already a part of the litigation, he or she soon will be."
A potential defense for the admitting physician is that the information relayed by the EP was not indicative of a more serious issue — even though the EP remembers relaying this information. Often, there is no documentation to support the EP’s version of events.
"Clear documentation of conversations, to include any lab or imaging results entered into the record in real time that were given to the other physician, will provide a good defense to any allegations against the EP," says Mitcham.
Sources
For more information, contact:
- Angela L. Carr, Esq., Partner, Barton Gilman, Providence, RI. Phone: (401) 273-7171. Fax: (401) 273-2904. E-mail: [email protected].
- Matt Mitcham, Senior Vice President Claims, MagMutual Insurance Company, Atlanta, GA. Phone: (404) 842-5655. E-mail: [email protected].
