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 2008, a man went to a hospital complaining of chest pains. The man’s treating physician at the hospital administered tests and diagnosed him with a peptic ulcer. The treating physician then instructed the man to follow up with his primary care physician. The man followed up with his primary care physician the next morning and again two days later for the ulcer. The man still was experiencing chest pains and was admitted to the hospital the same day. He was monitored in the hospital for two days, during which time his heart rate and pulse were fluctuating. He was discharged and told to follow up with his primary care physician in one week. However, the man’s chest pains continued, and he returned to the hospital the next day. He was seen by the treating physician he saw on his initial visit, who performed an evaluation and again diagnosed him with a peptic ulcer. He was admitted back to the hospital, where he died from heart failure that day. An autopsy revealed that he had no ulcer and that the cause of his death was hemopericardium and a rupture of his left ventricle. A malpractice lawsuit was filed on behalf of the man against the hospital, the treating physician at the hospital, the man’s primary care physician, and the medical center where the man’s primary care physician was employed. The lawsuit alleged that all the providers failed to adequately test for the man’s heart condition, which went untreated as a result and ultimately led to his death. The providers denied liability. The jury agreed with the man’s estate and found it negligent not to administer more diagnostic tests or to refer the man to a specialist regarding his chest pains and heart condition. The jury further found that the primary care physician was the only party that fell below the standard of care and that the treating physician and hospital were not negligent. As such, the medical center where the primary care physician was employed was held liable for the $950,000 jury award, which consisted of $400,000 for financial loss, $450,000 for pain and suffering, and $100,000 for disability.
Background: On Oct. 6, 2008, a 73-year-old man went to the hospital with chest pains. The treating physician at the hospital administered tests, one of which was a cardiac enzyme test to determine if the man had suffered a heart attack. The physician concluded that the man was suffering from a peptic ulcer and instructed him to follow up with his primary care physician. The next morning, the man followed up with his primary care physician for the peptic ulcer. On Oct. 9, 2008, the man still was experiencing chest pain and returned to his primary care physician before being admitted to the hospital that day. He was monitored in the hospital for the following two days, during which time his heart rate and pulse were reportedly fluctuating. He was discharged on Oct. 11, 2008, and informed to follow up with his primary care physician in one week and a second doctor the following week.
The man’s chest pains continued, and he decided to return to the hospital the following morning on Oct. 12, 2008. The man again was seen by the physician who had diagnosed him with an ulcer, took the cardiac enzyme test, and referred him to his primary care physician. The treating physician evaluated the man and again diagnosed him with a peptic ulcer. The man was admitted to the hospital. That same day, while at the hospital, the man’s heart stopped, and he was pronounced dead. An autopsy revealed that he was not suffering from an ulcer but that the cause of the man’s death was hemopericardium, which is an accumulation of blood in the heart, and a ruptured left ventricle.
The man’s estate filed a wrongful death action alleging medical malpractice on behalf of the hospital, the treating physician at the hospital, the man’s primary care physician, and the medical center where the man’s primary care physician was employed. The lawsuit particularly alleged the healthcare providers committed negligence by failing to adequately test for or diagnose the man’s heart condition, which would have included a diagnostic test for atherosclerosis, additional cardiac enzyme tests, and tests to determine if the man suffered cardiac ischemia in light of his fluctuating heart rate and other symptoms. The lawsuit alleged these tests would have detected the man’s heart condition and prevented his death. All of the healthcare providers in this case denied liability.
In a jury deliberation lasting only four hours, the jury found that the man’s death was caused by his heart condition and that it was negligent not to adequately test for it or refer the man to specialists. However, the jury found that it was only the man’s primary care physician who fell below the standard of care in this regard, and the jury did not find that the hospital or the treating physician provided inadequate care. The jury particularly found that the man’s primary care physician failed to administer proper cardiac testing or refer the man to a specialist when he saw the man and learned of his condition, and that because the physician was an employee of a medical clinic, the medical clinic where he worked was liable for the $950,000 jury award. The award went to the man’s estate and consisted of $400,000 for financial loss, $450,000 for pain and suffering, and $100,000 for disability.
What this means to you: This case demonstrates how administering relevant tests and referring a patient for follow-up care can shelter a physician and the physician’s employer from legal liability. In this case, the treating physician who saw the man twice at the hospital, and twice misdiagnosed him with a peptic ulcer, was not found to have acted negligently for failing to diagnose the man’s heart condition, but the man’s primary care physician at a separate healthcare facility was found negligent for it. The liability-sheltering acts on behalf of the treating physician were the initial cardiac enzyme test and informing the man to follow up with his primary care physician. However, the primary care physician was found to be negligent for failing to administer diagnostic testing for cardiac issues or to refer the man to a specialist in light of his continued chest pains and other symptoms.
As illustrated by the jury’s decision and the acts by the treating physician at the hospital, the administration of diagnostic tests and referring the patient to the next step of care can shelter physicians and hospitals from legal liability. As such, prudent physicians and hospitals should be encouraged not only to consider the benefit to the patient when ordering diagnostic tests, but also to consider the positive, liability-sheltering effects of administering diagnostic tests and making physician referrals.
The jury decision in this case also demonstrates that each physician has a separate responsibility to each patient and can be held independent-ly liable when a patient suffers harm while seeing multiple physicians. The patient in this case was sent to the primary care physician with an incorrect diagnosis of a peptic ulcer and complaining of chest pains, yet the primary care physician was held to be negligent by the jury for being the physician who failed to adequately test for or diagnose his heart condition. While the primary care physician was made aware of his chest pains, saw the man twice, and failed to administer diagnostic tests for his heart condition, he did not actively misdiagnose the man or otherwise commit a direct harmful act.
Each physician has a separate obligation to diagnose and treat a patient, and independent liability can result from failure to do so. This liability is demonstrated by the fact that the primary care provider was considered negligent, with his employer being liable for all the damages in this case, despite the man being misdiagnosed by another physician. Bearing this fact in mind, physicians treating patients who have been sent to them by other physicians should not rely solely on the findings of the fellow physicians and should administer tests and otherwise treat the patients as if they themselves are independently liable for harm that might befall the patients.
Finally, as in the preceding case studied in this article, this case likewise provides a platform for a short discussion on the importance of good documentation. It is important for a physician in a chain of treatment to have documentation from start to finish: what information and instructions are being handed off to the physician, what is done with and said to the patient, and what information and instructions then are handed downstream to the subsequent provider. A lack of strong documentation makes it more difficult to defend oneself against efforts by other physicians to shift blame in a case involving a chain of treatment.
REFERENCE
Ford County Courthouse, Illinois Case No. 2011L16 (Dec. 11, 2015).
