By Damian D. Capozzola, Esq.
The Law Offices of Damian D. Capozzola
Los Angeles
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Los Angeles
David Vassalli, 2016 JD Candidate
Pepperdine University School of Law
Malibu, CA
News: In 2012, a man involved in a logging accident severely injured his back. He was transported to a local hospital, where a physician ordered X-rays of the man’s back. During the course of the man’s X-rays, he complained of being in too much pain to complete the thoracic spine series the physician had ordered. The X-ray technician ceased the X-ray process, and the physician sent the incomplete series of X-rays to a radiologist for review.
The radiologist took nearly six hours to file her report. The report allegedly was unclear as to the severity of the man’s back injury and failed to include a recommendation for a CT scan, that the patient should be immobilized, and that he should be treated as a potential spine fracture patient. The man spent an additional three days in the hospital before being released by a second physician. The man, who was suffering from an undetected fractured spine, then spent another two days at home and experienced extreme pain for those two days. The pain became so extreme that he had to be life-flighted to another hospital, where it was determined the man was now a paraplegic. He spent the next two months at the second hospital learning how to function as a paraplegic and undergoing life-threatening surgeries to battle blood clots and other complications.
The man filed a medical malpractice suit against the first physician for not following up on the X-rays or ordering a CT scan, the radiologist for her unclear report and for failing to warn the physicians about the man’s condition, and the second physician who released the man with a broken back and ribs. The jury found the physician who released him was held 50% liable, the physician who failed to administer all of the X-rays was held 30% liable, and the radiologist who filed an unclear report was held 20% liable. The radiologist works at a separate facility, and the two physicians work in the same hospital. As such, the hospital with the two physicians was held 80% liable and the group with whom the radiologist works was held 20% liable for the $2.2 million jury award.
Background: In the summer of 2012, a man in the logging industry was struck in the back by a 500-pound treetop. He arrived at a nearby hospital on a backboard and was sent for X-rays of his back.
After images were taken of the spine region below where the tree struck the man’s back, but before X-rays were taken of the rest of the man’s back, the man complained that the pain was too extreme for him to get into the necessary positions to complete the examination. The hospital was equipped to administer a CT scan, which would have allowed the man’s back to be fully examined without having to be repositioned, but the man was not offered or given a CT scan.
The physician sent the incomplete series of X-rays to a radiologist for review. The review took six hours, and recommendations were not made for a CT scan, for the man to be immobilized, or for the man to be treated as a potential spine fracture patient. The man spent two additional days in the hospital and was never given a CT scan or follow-up X-rays to discover the fracture in his spine in the region where the 500-pound treetop struck his back. After two more days of pain in the hospital, his attending physician released him.
The man spent two painful days at home before the pain became unbearable. The man then was life-flighted to another hospital for treatment of his back. However, the man was paralyzed by the time he arrived at the second hospital. In addition to being paralyzed from the waist down, the man had to undergo life-threatening care for blood clots and infections. As a result of the incident, the 50-year-old man permanently lost his ability to walk, had to relearn how to do simple tasks, and described his current state as living in a “3-foot by 3-foot prison cell.” He filed a medical malpractice suit against the physician for not following up on the X-rays or ordering a CT scan, the radiologist for her unclear report and for failing to warn the physicians about the man’s condition, and the other physician who released the man with a fractured spine and broken ribs.
At trial, a surgeon at the second hospital told the jury that if the man had been given proper care, including obtaining complete images of his back and immobilizing him, that the man would be walking today. The jury awarded the man $2.2 million and found the physician who released him was held 50% liable, the physician who failed to order all of the X-rays was held 30% liable, and the radiologist who filed an unclear report and failed to investigate further was held 20% liable. The radiologist works at a separate facility that was held responsible for her 20% liability. The two physicians work in the same hospital that, accordingly, was held 80% liable. The award consisted of $300,000 for past pain and suffering, $1.7 million for future pain and suffering, and $200,000 for the man’s wife’s loss of consortium.
What this means to you: This case illustrates that the duty of care a physician must follow doesn’t dissipate because of a patient’s complaint. In this case, the man struck with a 500-pound treetop required a complete series of images of his spine. Despite his complaints of pain and not wanting to continue the examination, the physician is expected to order the necessary tests to uncover vital and life-altering information, particularly when a reasonable alternative is readily available. Had the man been given a CT scan or been strongly urged to complete the examinations, the fracture in his spine likely would have been detected, he would not be paralyzed, and the hospital employing the two physicians who failed to order the required test and released the man without them would have avoided liability. As such, a prudent physician dealing with a patient who cannot complete a necessary examination should seek alternative means of obtaining the necessary information, urge the patient to continue if it’s reasonable to do so, and then document the courses of action the physician took, including the alternatives offered and whether the patient is refusing treatment.
In this case, providing pain relief before sending the patient to radiology should have been the physician’s first course of action after having ruled out contraindications such as a head injury. Immobilization, which occurred in the field with the use of a backboard, should have been continued in the emergency department until the need was ruled out through diagnostic studies. Had the physician fully considered that an item weighing 500 pounds that falls from a distance and lands on a person will cause bodily injury, he probably would have handled the patient differently. If this information had been communicated to the radiologist reading the results, her recommendations might have included additional studies and immobilization.
Another lesson from this case is that each physician has a separate duty of care he or she must satisfy, yet liability can arise from work of another physician. This situation is seen in the radiologist’s 20% liability. The radiologist reviewed all the material she was sent from a separate facility and gave her medical opinion. However, the radiologist was held liable for not recommending that other physicians administer more tests or treat the patient, whom she had never seen, as a spine fracture patient. This situation demonstrates that the radiologist cannot avoid liability simply by relying on the sensibilities of other physicians. Rather, the radiologist had a separate duty to the patient for whom she is separately liable and responsible. Bearing this duty in mind, physicians and hospitals seeking to avoid liability must evaluate the condition and circumstances of each patient to whom they provide medical care, even if their role is to evaluate the test results of another physician’s chosen course of action.
REFERENCE
Crawford County Court, Pennsylvania, Case Number 13 AD-2012-1473 (Oct. 30, 2015).
