Risk manager shares lawsuit experience
Risk manager shares lawsuit experience
Dealing with a patient’s claim of mistreatment and a subsequent malpractice suit is never a pleasant experience, but Reflex Sympathetic Dystrophy (RSD) can pose special challenges to the risk manager. While the patient’s complaint may seem wholly unrelated to care at your facility, RSD is a legitimate medical condition.
The experience of risk manager Doug Jaquez, MHA, at Merle West Medical Center in Klamath Falls, OR, illustrates some of the frustrations that are likely in dealing with an RSD claim. Jaquez provides Healthcare Risk Management this account of his current malpractice claim concerning RSD:
A woman sought treatment in the emergency department (ED) Dec. 24, 1996, complaining of pain in her left shoulder and arm after bumping it on a clothing rack at a local retail store. She is first seen by a nurse practitioner, who obtains a history and orders X-rays. The nurse practitioner also receives a note from the woman’s physical therapist at the hospital, stating that she is under his care for an as-yet undiagnosed upper muscular disorder.
X-rays show no fracture
An emergency physician then examines the woman and, seeing that the X-rays show no fracture, he performs a normal shoulder exam that includes light range of motion.
The doctor makes a diagnosis of "contusion left shoulder." The doctor never sees the note explaining that the woman was in physical therapy, but the woman explains to him during the exam that her range of motion is limited.
The woman goes to her hospital-employed physical therapist as usual the next week. She recounts the ED care to the therapist, who tells her that the physician should not have done the range-of-motion test.
Eight days after the emergency visit, the woman calls Jaquez to complain that the physician was negligent and that the hospital should compensate her. She wants the hospital to pay for all of her medical bills until she feels better and pay all of her lost wages until she is able to return to work full time.
Jaquez tells the woman he will investigate the matter and to keep her regular appointment with the orthopod. When consulted, the emergency physician claims that his care was 100% appropriate and offers to testify to that fact in court. The risk manager then talks to the orthopod treating the woman, and he says it is doubtful that the emergency department exam caused the woman’s injury. Though he diagnoses RSD in the woman, the orthopod tells the risk manager that it most likely was caused or exacerbated by the bump in the department store, not the physician’s exam.
Since the hospital-employed therapist had told the woman that the exam probably hurt her arm, the risk manager decides to settle for a nominal amount. The orthopod and therapist both recommend paying for two months of therapy. In addition, Jaquez offers to pay for the emergency visit and her orthopod bills for two months, and he includes money for pain and suffering.
The woman refuses, insisting that the hospital take responsibility for causing her RSD and agree to an open-ended agreement that would cover her medical expenses and lost wages until she feels better. The risk manager refuses. He makes the same offer a second and third time the next week and is turned down.
Finally, the woman tells the risk manager that she is suing the emergency physician and the hospital for giving her a "gimp arm." Her attorney contacts the hospital the next day. t
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