Presentation
A 35-year-old woman came to a family practice clinic on July 31 with complaints of right arm and finger numbness and neck pain. She had a history of lumbar surgery six years ago and lumbar fusion five years ago. The patient also reported that she was seeing a psychiatrist for anxiety, depression, and mood swings. She was currently taking Paxil 40 mg and Thorazine 150 mg. The patient stated that her neck felt like her back did before the fusion.
Physician action
A physician’s assistant (PA) examined the patient and found that she was tender on palpation of the cervical vertebrae and shoulder with a tight trapezius muscle. She was noted to have decreased range of motion of the neck and decreased right arm strength. The initial assessment was neck pain, shoulder pain, neuropathy, and muscle weakness to the right arm. She was prescribed a Medrol dose pack, Darvocet for pain, and Soma for muscle spasms. The office scheduled an MRI of the cervical spine on August 5.
On August 1, the patient called the office complaining of pain. Another PA, with the approval of the supervising physician, called in a prescription for Lortab 10/500 #20 for the patient. The patient did not keep her appointment for the MRI that was scheduled on August 5. On August 6, the patient was
N
ot all medical liability suits filed against physicians are prompted by medical errors. Patients often cite interpersonal aspects of care, such as poor communication or feeling rushed, as central to the decision to initiate litigation. 1
“Patients do not necessarily file lawsuits because they believe they were harmed by a medical error. They sue because they believe they were harmed by a medical error and something else happened during their care,” says Jane Holeman, vice president of risk management at TMLT.
This publication will describe 10 common errors that can increase the risk of a malpractice suit, and offer risk management techniques to address these issues. Included with each error is a TMLT closed claim study that demonstrates how the error led to a lawsuit alleging medical liability.
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prescribed Phenergan, Soma, and Lortab, but Family Physician A denied the request for Darvocet. The patient again called and obtained refills for Phenergan, Soma, and Lortab on August 9.
On August 12, the patient called for refills — Lortab, Soma, Restoril, and Paxil were prescribed with the understanding that no more medications would be prescribed until her MRI was completed. Office staff then contacted the patient’s psychiatrist to determine what medication he was prescribing for the patient. The psychiatrist would not respond to their call or fill out the medication form that was sent. The psychiatrist noted that the patient had signed a form that would not allow him to release any information about her care and treatment.
The patient failed to show for the MRI that was scheduled for August 19. When she called on August 23 seeking a refill for Soma, Family Physician B denied the request because the patient had not obtained the MRI.
On August 23, the MRI scan of the cervical spine showed a large right paramedian disc protrusion at C6-7 with a mild impression on the anterolateral aspect of the spinal cord. There was also a large paramedian disc protrusion at C5-6 producing mild neuroforamenal stenosis and pressing upon the right anterolateral aspect of the cord. The MRI results showed changes that would explain the patient’s pain. On August 26, Family Physician B called the pharmacy to approve another 5-day supply of Phenergan, Lortab, and Soma.
The patient called the office on August 28 stating that her pain medications were not strong enough. Family Physician B requested that she return to the clinic for a follow-up visit. The patient came that day and complained of neck pain and numbness in the right arm. Family Physician B performed a complete physical exam. He noted that her right arm was weaker than her left, and the right trapezius muscle was tender to palpation. The patient mentioned that Darvocet had not helped her in the past; but Oxycontin had provided relief. The physician diagnosed cervical disc disease, hypertension, and fatigue. He prescribed 40 mg of Oxycontin to be taken twice daily; one Soma every six to eight hours; and for her to keep a log of her blood pressure. Additionally, he noted that he would schedule an appointment with the neurosurgeon for September 26. He ordered a follow-up visit in two to three weeks for a blood pressure check.
At this visit, Family Physician B specifically remembered telling the patient not to take other medication when she took Oxycontin. He also remembered telling her to begin by taking only one pill per day though he wrote the prescription for two pills per day. He recalled providing specific patient education about the risks of Oxycontin.
On September 1, the patient called the clinic complaining of pain. The prescription for Darvocet was refilled to treat the patient’s breakthrough pain. The patient’s psychiatrist prescribed a 30-day supply of Restoril to the patient on September 2.
Today’s visit
Patient’s name _____________________________________________ Date of birth __________________
Main reason for today’s visit:
Other concerns I would like to discuss if there is time:
Please check all that apply:
_____ I have prescriptions to be refilled ______ I need the attached forms filled out
_____ I need a school or work excuse ______ I need a referral for my insurance company
This form can help prompt patients to state the reason for their visit.
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The following day, the patient’s husband found his wife in the garage passed out and covered in urine. He explained that since he found her at 2 a.m., he thought her condition was a side effect of drowsiness. Neither the patient nor her husband notified any medical providers of this incident.
On September 5, the patient was found dead by her minor children on their return home from school. The medical examiner found that the cause of death was an accidental mixed-drug overdose from Oxycontin and Darvocet. The pathologist stated that he believed the patient consumed Oxycontin and Darvocet well in excess of the instructions in the prescription, and that this was not a case of accidentally taking an extra pill or two. He did not believe it was a suicide because the patient did not consume all the pills from the bottle or leave a note. The cause of death was also not a homicide or natural, so he was left with accident as the only choice when completing the death certificate. Based on the toxicology results, the patient took at least 8 to 10 Oxycontin and at least 6 to 8 Darvocet on the morning of her death.
Allegations
Lawsuits were filed against Family Physician A, Family Physician B, and their practice. The plaintiffs alleged that the physicians failed to realize that the patient was a drug abuser and should have taken steps to place the patient under long-term pain management care.
Lawsuits were also filed against the psychiatrist, the pharmacy and pharmacist who filled the patient’s prescriptions, and the physician’s assistant at the family practice clinic.
Legal implications
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Originally Posted by GodfatherofSoul
