Medicolegal Lessons: A question of duty

The family argued that Dr. Hospitalist had a duty to question the nurse regarding ML’s condition and, because of the evidence for obstruction on the film, see ML for an assessment. The family argued that Dr. Hospitalist’s misinterpretation of the film (i.e., colon dilatation in the face of obvious small bowel dilatation) represented gross incompetence.

Dr. Hospitalist testified that she had no memory of ML, this case, or what she may or may not have told the nurse that night. ML’s medical record confirms that Dr. Hospitalist wrote no orders or charted any notes on her. The only documentation of Dr. Hospitalist’s "wet read" was in ML’s nursing notes.

The GI consultant testified that he had no memory of his call from the nurse with the radiograph results. The nurse testified that she wouldn’t have written "colon dilatation" if Dr. Hospitalist had told her it was small bowel.

Conclusion

The "house doc" role typically encompasses a limited scope of responsibility. But all physicians carry a professional duty to the patients that we become involved with.

By performing a "wet read" on a film of ML, Dr. Hospitalist established a doctor-patient relationship. It would have been prudent for Dr. Hospitalist to record her film interpretation herself (thus creating an opportunity for brief chart review), and to call the GI consultant with the information instead of relying on the nurse. A 1-minute conversation between Dr. Hospitalist and the GI consultant may have led to further intervention by either party.

Ultimately this case was resolved for an undisclosed amount. In the "house doc" role, Dr. Hospitalist was functioning as an employee of the hospital (despite being an independent contractor), and there were hospital care issues independent of Dr. Hospitalist. However, Dr. Hospitalist could have avoided her role in this suit with better documentation and communication.

Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. Read earlier columns online at ehospitalistnews.com/Lessons.