Medical Malpractice Insights: Back to Basics

Back to basics: Take a history. Examine the patient.

And listen to your EMS providers and nurses.

Facts: A 65-year-old male is found by his employer on the floor, unable to speak or get up, lying in a pool of blood from apparent facial injuries. EMS is called, and he is brought to the ED for a reported “slip and fall” with associated facial abrasions. He is awake and denies any preceding symptoms, falls, or loss of consciousness. EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. None of this is otherwise communicated to the ED provider – only noted in reports. Care is limited to cleaning and dressing the patient’s abrasions and he is then discharged. Later that day the patient is found on the front porch of a neighbor’s house. He is confused, his wallet and shoes are missing, and his pants are around his ankles. Facial trauma is noted but EMS has none of the information from earlier in the day. He is transported to a different hospital as possible trauma. There, his initial neuro exam is documented as normal, but a head CT reveals evidence of a possible acute CVA in the right hemisphere. Patient then develops [Editor’s Note: Or perhaps is noted to have] left sided weakness and neglect. He is eventually diagnosed as having a large right ICA thrombus with downstream embolism and MCA infarct. He is treated with aspirin and clopidogrel, but the infarct and symptoms progress. When discharged he requires a feeding tube and continuous care at a SNF. A lawsuit is filed against the first hospital and ED physician.

Plaintiff: Both EMS and the nurse documented the presence of symptoms suggestive of a possible CVA. You either didn’t read that or ignored it. Your exam was superficial and based on your own presumption that this was nothing more than a “slip and fall.” If you had examined my client appropriately, you would have discovered the cause of his “slip and fall.” He could then have been treated for his stroke and not have to be in a nursing home for the rest of his life.

Defense: The defense acknowledged that the discrepancies among the EMS, nursing, and physician documentation were apparent and difficult to defend. They also acknowledged being faced with an involved family and a sympathetic plaintiff with massive damages and the need of high-level lifelong care. Pre-trial settlement negotiations ensued.

Result: The hospital agreed to a seven-figure settlement during mediation. The physician settled for a lesser seven figure amount after refusing to pay the plaintiff’s demand for policy limit.