Timing is everything

Regardless of the truth, the plaintiff argued that somebody made a mistake and it cost Mrs. S.L. her life. The defense countered with the argument that regardless of when the diagnosis was made, the outcome most likely would have been the same.

Conclusion

Mrs. S.L. suffered a known complication from anticoagulant therapy. Whether there was a delay in diagnosis and treatment that could have been averted, an adverse outcome remains unknown. However, Dr. Hospitalist did not help himself in several important respects.

First, he did not speak with the family after the unexpected transfer to the ICU. A demonstration of empathy may have gone a long way to avoiding the lawsuit altogether. As it was, the family interpreted Dr. Hospitalist’s reluctance to speak with them as an admission of guilt. The plaintiff further used this to portray Dr. Hospitalist to the jury as a callous physician.

Second, Dr. Hospitalist was in the habit of writing orders that were not dated or timed. The plaintiff held this up as an example of "sloppy work" – Dr. Hospitalist was not only callous, he was lazy as well.

In the end, Dr. Hospitalist was adamant that he had written orders for a STAT head CT immediately after his evaluation of Mrs. S.L. and that he did not alter the medical records. Nonetheless, he chose to settle with the plaintiff for an undisclosed amount before the jury had a chance to return a verdict. A post-trial jury survey confirmed that Dr. Hospitalist had little credibility with the jury and that he had made a wise decision to settle when he did.

Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He has been involved in peer review both within and outside the legal system.