Medical Malpractice Insights: SCFE – Who called whom and when?
Author: Chuck Pilcher, MD FACEP (Editor, Med Mal Insights) // Reviewers: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFLis to improve patient safety, educate physicians, and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Chuck Pilcher, MD, FACEP Editor, Med Mal Insights SCFE: Who called whom and when? “Who?” “What?” and “I don’t know.” Another version of Abbott & Costello’s classic skit “Who’s on first” Facts: An 11-year-old female feels a sudden pain in her L hip while doing a flip turn during swimming practice. She sees her PCP a week later and is diagnosed with a “groin strain.” The pain persists and she is re-examined by different PCP a few days later. The dx is changed to “adductor strain.” A month later she falls and feels a “pop” in her hip and is taken to the ED. An x-ray of her hip reveals a slipped capital femoral epiphysis (SCFE). The EP claims that Orthopedist A is contacted and advised that the patient can be seen in the office. The name of Orthopedist A is not recorded. The patient is seen by Orthopedist B and undergoes fixation stabilization 4 days later. Avascular necrosis (AVN) develops and the pt requires a total hip replacement. An attorney is contacted and a lawsuit is filed claiming delay in dx caused the avascular necrosis. The lawsuit named the first 2 PCP’s for delay in diagnosis. The EP and orthopedist A and/or B were all named for an inappropriate delay in surgery. Plaintiff: The first two PCP’s missed my diagnosis. They didn’t even do an x-ray. The EP made the correct diagnosis, claimed he spoke with Orthopedist A but didn’t document it and allowed Orthopedist A to convince him that immediate surgery was unnecessary. Phone records show that it was actually Orthopedist B with whom the EP spoke, so we’re suing both of them. Defense: Orthopedist A testifies that he was “on vacation” on the day of the ED phone call. Orthopedist B testifies that he wasn’t called because “If I was called, I would have operated immediately.” The surgery was successful. Avascular necrosis is a potential complication no matter when the fixation stabilization is done. Result: Because of all the unknowns in this case, the various parties agreed to settle for undisclosed amounts pre-trial. Takeaways: If you speak with a consultant, identify him/her/them, what advice you were given and why you did or did not follow it. Share the agreed upon plan with the patient, e.g., “Dr. X recommends Y. He and I have discussed this and you should follow up according to our plan.” One cannot prove when the slipped epiphysis would have manifested itself on an x-ray. It could have been at the time of the swimming incident or only after the fall a month. Once SCFE is identified, surgical stabilization should be done ASAP. That said, the role of timing as a cause of complications like AVN remains a debatable issue. SCFE classically presents in an overweight adolescent with non-radiating, dull, aching pain in the hip, groin, thigh, or knee, and no history of trauma. Reference: Slipped Capital Femoral Epiphysis Treatment & Management. Walter KD. Medscape eMedicine. Updated Sep 29, 2023.
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