Patients who fail to take charge of their health care needs present a real threat to the practitioner. Rather than relieving the physician from his or her duties, a patient’s recalcitrance can instead amplify the urgency for action.
A 55-year-old morbidly obese woman with diabetes was a longtime patient of Dr. GP, a general practitioner. Over those years, the patient was at times non-compliant with regard to her diabetes management and in obtaining labs and other studies that Dr. GP ordered.
In an early November visit to Dr. GP, the patient complained of pain and swelling in her left knee and pain over the right kidney. A urinalysis showed a trace of blood but was negative for proteins, nitrites, or leukocytes. When the right CVA pain persisted in a return visit five weeks later, Dr. GP scheduled the patient for an abdominal ultrasound and another round of UA tests.
For unexplained reasons, the patient delayed getting the urinalysis for nearly seven weeks. When finally collected, the urine culture showed a significant Klebsiella pneumoniae infection sensitive to 12 separate antibiotics. Upon receiving the information, Dr. GP noted the positive Klebsiella culture and wrote in the chart: “re-see, as needs TX.” The next chart notation is a “no-show” for an appointment two weeks later.
According to family members, however, the patient called Dr. GP’s office three times for the test results around the date of Dr. GP’s notations but was told the culture results were not available. According to her daughter, the patient made another call to the office (a week before the “no show” appointment date) saying that she was “getting worse,” but was unsuccessful in her request to be seen that day.
Several hours after that reported call, the patient’s husband and son took her to the hospital, where she was diagnosed with leukocytosis, diabetes, urinary tract infection, hypertension, and morbid obesity. She reported flu-like symptoms for a week, a cough beginning that day, difficulty breathing, and diarrhea. Her white blood count was 21,600.
The ER physician ordered Gentamicin and documented his plan to rule out sepsis. While in the ER, however, the patient arrested and a code team commenced CPR. Multiple doses of epinephrine restored the patient’s vital signs, but not her neurological system. At the family’s request, the patient was removed from life support a week later and died. The death certificate listed cause of death as respiratory failure, renal failure, and sepsis from a urinary tract infection.
The patient’s husband sued Dr. GP for medical negligence, with the focus of the case being Dr. GP’s failure to call in a prescription for an antibiotic upon his learning of the Klebsiella infection. Dr. GP and the husband-plaintiff resolved the claim informally before going to binding arbitration.
Whatever the reasons for the patient not being contacted with a prescription, the woman’s own significant delay in submitting to the lab tests provided no “defense” to the lawsuit. That is because if an expert witness can testify that a physician’s actions could have made a difference in even a difficult patient’s outcome, “blaming the patient” is never an available strategy.
Author Gordon Ownby is General Counsel for the Cooperative of American Physicians, Inc.(CAP).
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.