Legal Review & Commentary-Transverse myelitis untreated: $1.6 million
August 1, 2000 4 minutes read
Legal Review & Commentary-Transverse myelitis untreated: $1.6 million
News: After several visits to emergency rooms with complaints of lower back pain, a woman was eventually hospitalized following the onset of paralysis. It was alleged that her transverse myelitis had been overlooked and had not been properly treated, resulting in permanent paralysis. The settlement with the associated hospitals and physicians totaled $1.6 million.
Background: Over the course of a week, the plaintiff went to the emergency room at two different hospitals on three occasions. Her chief complaint was numbness and pain in her feet and legs that was radiating to her lower back. Each time she presented to the emergency departments, she was told that she had a back sprain. All three times she was discharged with instructions to take pain medication and rest.
At the end of that week, she woke up one morning, paralyzed from the waist down. She was taken to a hospital and received palliative care from a neurologist who discharged her to a rehabilitation hospital. One week later, she was readmitted to the hospital with complaints that the paralysis was moving up her body. The patient was given steroids based on a consult from a renowned teaching hospital's neurologist. After the administration of the steroids there was no further progression of the paralysis, though she remains paralyzed.
Plaintiff claims
The plaintiffs claimed that emergency room physicians on the second and third visits and their respective hospitals as well as the treating neurologist were negligent in not diagnosing and treating her transverse myelitis in a timely fashion. The plaintiffs also argued that more thorough work-ups in the emergency room were merited and should have yielded an appropriate diagnosis. They claimed that, at the very least, the emergency room physician involved in the third hospital visit, a retired family practitioner on contract through an agency that supplied emergency room physicians, should have
sought an appropriate consult.
In addition, that particular emergency room physician recently had been the subject of two medical malpractice claims. Further, the plaintiff maintained that if the transverse myelitis had been detected earlier, the paralysis could have been prevented through the more timely administration of steroids.
All of the defendants strongly held that transverse myelitis is extremely rare and that emergency room physicians should not be expected to routinely diagnose the condition. In addition, all defendants maintained that even if the condition had been identified, there is no proven effective method for treating transverse myelitis. Both hospitals and the emergency room physician who treated the plaintiff during her third emergency room visit settled for a combined total of $600,000 prior to a suit being filed. The treating neurologist ultimately settled for his medical malpractice insurance policy limit of $1 million.
What this means to you: The driving force behind the facilities' settlements in this case is
the patient's poor outcome. As far as the hospitals' liability is concerned, the outcome seems to have been more the result of process breakdowns rather than basic medical error. But more dramatic outcomes tend to lend themselves to more heightened scrutiny, making the facilities and practitioners more vulnerable to liability. It appears that the hospitals' willingness to settle the case was influenced by the questions that could be raised regarding their credentialing processes, particularly with the emergency room physician.
Another view
"In situations involving multiple facilities and multiple hospital-based physicians, one should always question whether or not the patient had appropriate access to care," notes Jane M. Bryant, DFASHRM, MHSA, risk manager at Oconee (SC) Memorial Hospital.
"It seems as though her condition did not get any worse or better until, of course, the morning she woke up paralyzed. And so, until that point, it seems that she was handled as a routine, non-acute emergency room patient. In the week preceding that fateful morning, there is no mention of her being referred to or attempting to see her primary care physician or any other nonhospital based caregiver. It seems that this patient was in part plagued by the inability to properly access the health care system. Systemic barriers to accessing physician offices in seemingly non-acute situations do exist," Bryant says.
Despite the issues of the patient's access, once she reached the hospitals' emergency departments, her care was in their hands. "The plight of smaller, more remote facilities is universal. It is difficult to find qualified, competent emergency department coverage on 24-hour, seven-days-a-week basis. Often, these hospitals resort to using agency personnel. However, as seen in this instance, it is still the facility's responsibility to assure that credentialing is properly done. Any time you are dependent upon someone else for credentialing, you should still set the criteria with regard to your medical staff," Bryant adds.
Outcome negates inquiry
While it seems debatable whether the emergency department physician was negligent in his failure to properly refer the patient to a specialist or be able to diagnose this relatively rare condition, the outcome in this instance essentially negates the inquiry. A perceived chink
in the armor regarding the credentialing of
the retired physician covering the emergency department may have opened the door to criticism of the facilities' processes enough to cause the hospitals to settle.
"With health resources dwindling, particularly in less densely populated areas, and with competition for these scarce resources, there is the need for caution in creating and/or staffing services, such as emergency departments, where expertise may be limited. Also, the processes for credentialing and medical management should be consistent throughout the organization. Caution should be exercised in creating programs to serve the community," Bryant concludes.
Reference
Peggy Archer, David Archer, Justina Archer, a minor, by Peggy Archer as natural guardian and next of kin, et al. v. Treasure Coast Emergency Associates, Inc., Richard Craddock, MD, 55 et al., St. Lucie County (FL) Circuit Court, Case No. 97-984 CA 1.
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