Medical Malpractice Insights: On-call trauma surgeon unavailable. Patient dies in ED.

On-call trauma surgeon unavailable. Patient dies in ED.

Plaintiff verdict for $30 million: A reminder to check your hospital’s call policies

Facts: A 24-year-old male bystander sustains a GSW to the back during a gunfight on an urban street in mid-afternoon. He is transported to the ED, where he is alert on arrival. A Trauma Alert is called, attempts are made to stabilize the patient’s vital signs, and the on-call trauma surgeon is immediately contacted. He is found in the OR doing an elective case and tells the ED physician to “call someone else.” ED staff try but cannot find another surgeon, so the on-call surgeon is called a second time. He again says “find a different surgeon.” After confirming they have no other options, they call the OR a third time. This time the response is “transfer the patient to the trauma center.” The patient dies in the ED before transfer can be arranged. A lawsuit is filed against the hospital (including the ED physician) the surgeon, his surgical group, the hospital’s trauma service director, and the hospital’s chief medical officer.

Plaintiff: The patient’s injuries required immediate surgery for internal bleeding. Yes, your hospital policies allow a surgeon to do elective cases while on-call, but only if he/she arranges for emergency coverage by another surgeon while in the OR. You didn’t do that. No surgeon ever evaluated the patient. Our client was victimized twice: first by being struck by a stray bullet, and second by an unavailable and irresponsible general surgeon who failed to follow your hospital policy.

Defense: We offer our condolences to the family.

Result: $30 million verdict to the family of the victim. Apportionment among defendants not disclosed.

Takeaways:

• Be certain that your emergency call schedule responsibilities are clearly defined in hospital policy. Follow those policies.
• An on-call physician for the ED must be able to respond in an appropriate time frame. Expected response times should be clearly stated.
• If not immediately available, a backup/surrogate must be designated.
• If a physician is allowed to be on call for more than one hospital – or to be in the OR when on call – define the procedure for simultaneous calls as well as when a surgeon is operating.
• As in the case reference below, the average hospital is not required to have a “backup for the backup.” A Level I trauma center should address this in its policies.
• The hospital’s Mass Casualty Policy should be implemented if only one trauma surgeon is on call and 2 or more patients arrive needing immediate surgery.
  

Reference:

See similar case in “Where’s all that blood coming from” in the November 2015 issue of MMI-LFL. https://madmimi.com/p/3bdde6