Medicolegal Issues

Was CT With Contrast Forgotten?

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For a 43-year-old man with a suspected aortic tear, CT with contrast is ordered but follow-up delayed.


 

At an Illinois hospital ED, a 43-year-old man under several physicians' care underwent a CT scan that indicated a possible tear in the aorta. The emergency physician ordered a second CT with contrast, but it was never performed. The emergency physician assumed the test was being done; the patient's cardiologist assumed that the emergency physician was having the test performed; his internist assumed the cardiologist was having the test performed.

Seven hours passed before the patient's aortic tear was diagnosed and he was prepared for surgery. While being transported to the operating room, he experienced cardiac arrest and died.

The decedent had no history of heart problems. Apart from smoking, he had had a healthy lifestyle.

The plaintiff claimed that the defendants failed to diagnose the decedent's condition in a timely fashion.

The defendant hospital admitted negligence but denied that its negligence was causally related to the man's death.

Outcome
According to a published account, the jury awarded $4.5 million, but the recovery was expected to be $3.35 million because of high/low agreements with five of the eight defendants: $2 million to be paid by the hospital, $500,000 to be paid by the emergency physician and his practice group, and $850,000 to be paid by the internist and his practice group.

Comment
This is a tragic case of poor communication. Everyone knew that a CT with contrast had to be performed, and it appears that one was in fact ordered. The emergency physician thought the procedure had been carried out, but it was not done. The other physicians, the cardiologist and the internal medicine specialist, believed that another physician had ordered the test. Seven hours seems like a long time to have passed before anyone realized the procedure was not done, but by then it was clearly too late.

EDs are busy and sometimes confusing places. It is just these circumstances that call for very clear processes to carry out orders, then report findings to the appropriate personnel. The potential chasm between order and report is often a source of medical malpractice, even in medical offices—but the outcome is not usually so dramatic as in this case.

Certainly the argument can be made that the outcome would have been the same. A tear in the aorta may lead to death even in the hands of the best surgeon and even when the patient is otherwise in the best of health. But when a jury sees such a clear case of communication failure as appears here, the outcome is predictable. They will assume that whatever chance this man had was wasted while he waited. —JP

Cases reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

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