Medical malpractice cases come in various forms.  Operating on the wrong extremity.  Leaving a piece of equipment inside a patient after surgery.  Failing to diagnose an illness.  These are among the most-common types of medical negligence taking place in America today.  This post looks at the premature closure of a case, which can result from bad assumptions.

Case Review

A 45-year-old male with poorly controlled diabetes, was admitted to the hospital with vomiting and weight loss, signs of a fever, and cough.  The ER doctor’s impression was hypoglycemia, weight loss due to diabetic gastroparesis, and upper respiratory infection.  Blood tests confirmed an elevated white blood cell count, and blood cultures revealed gram-positive cocci in chains.  However, the patient was discharged on antibiotics before the final culture and sensitivity report was available.

The patient followed up with his PCP a week later.  He had less abdominal pain, but no appetite.  Three weeks later, he returned with complaints of swollen legs.  Later that same day, he went to the ER with difficulty breathing, fever, and heart rate of 120.  He was diagnosed with mitral and aortic valve endocarditis.  Turns out, the results of the prior culture demonstrated Streptococcus viridans–so his antibiotics needed to be switched.  He underwent valve replacement, developed severe left ventricular decompensation, and died from end-stage congestive heart failure before a heart transplant could be performed.

Discussion

Medical experts who reviewed the case concluded the PCP should have done an aggressive workup to rule out endocarditis when he first received the blood culture results.  The chains of gram-positive cocci should have alerted the doctor of the possibility of Streptococci, and treatment should have been started at that time.

The patient’s initial improvement likely led the PCP to premature closure.  The PCP prematurely stopped the diagnostic process and did not order an additional workup because of another psychological phenomenon called optimism bias.  The PCP focused on the improved abdominal pain and believed there was minimal risk of a negative outcome; he likely convinced himself of the potential for a positive outcome, even if that potential was slim.

The negligence here is that it is essential to review final blood culture results, and sensitivity reports, and not assume the patient’s initial improvement is a predictor of a successful outcome.  Arguably, the PCP never engaged in critical thinking and relied on the fact that most patients will not end up with permanent injury or death.

Depending on when the final culture and sensitivity report would be available, the ER doctor might have been negligent for prematurely discharging the patient with an ineffective treatment or for not making sure the patient knew the results of the blood cultures showed the antibiotics he was given would not be effective against his infection.

This case study, again, comes from the nation’s largest physician-owned medical malpractice insurer, The Doctor’s Company.  The Doctor’s Company has a vested interest in eliminating preventable medical errors. So do I. Too many people have their lives catastrophically impacted by negligent doctors and health care providers. No one should have to suffer because of another person’s carelessness.

Contact us if you would like to have experienced medical malpractice attorneys analyze the facts of your case to determine if medical negligence occurred.

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