(originally printed in March 08):
A 35-year-old presents to the ED complaining of a swollen tongue of several hours duration. On arrival, he is having difficulty breathing and speaking. He believes that he is having an allergic reaction to erythromycin that was prescribed by his primary care physician. When he arrived, he told the medical staff that he had a heart murmur. In triage, the patient had a fever of 102 degrees and was mildly anemic. By the time the patient was evaluated by the physician, his tongue swelling had gone down. The EP called the patient’s primary care physician and discussed the case. The patient was instructed to see his primary care physician as soon as possible and went to see his physician that same day.
EP loses big for not spotting diagnosis that was not related to the chief complaint. After a trial, the jury entered an $18.5 million judgment against the emergency physician and the hospital.Another look at the facts:
In this case, the facts were taken from the appellate court’s opinion, so they may be incomplete in some regards. The plaintiff alleged that the emergency physician was negligent because he failed to detect the plaintiff’s endocarditis and alleged that the emergency physician’s negligence was a direct cause of the patient’s stroke.
How should a reasonably well qualified emergency physician treat a patient who was already taking oral antibiotics and who had transient swelling of the tongue, transient difficulty breathing, and transient difficulty speaking with a fever of 102 degrees and no source?
How the case was decided:
The plaintiff’s expert testified that endocarditis often presents as a fever and a heart murmur and that an appropriate history and physical examination would have led to appropriate testing and would have averted the patient’s stroke.
My verdict is that the physician may have needed better legal representation. Even though I believe the physician’s actions met the standard of care, his apparent lack of trial preparation caused him to admit negligence during court testimony. The issues in this case underscore the importance of finding a knowledgeable and experienced defense attorney when you have been accused of medical malpractice.