An unfortunate twist

The plaintiff countered that mechanical bowel obstruction (not necessarily a rare volvulus) was always in the differential diagnosis for acute and severe abdominal pain, and the failure to perform plain radiography of the abdomen was in and of itself negligent. Plaintiff experts opined that had the providers in this case performed plain radiography as the standard of care required, FR’s rare diagnosis would have been discovered, even if by "accident."

Conclusion

Dr. Hospitalist documented a desire to obtain a plain abdominal radiograph, but he ordered it routine and therefore it was never performed prior to FR’s death. Had Dr. Hospitalist obtained the film STAT, more likely than not the volvulus would have been identified well within the window to get FR a surgical consult and to the operating room for treatment.

This case is another example of what turned out to be an incomplete workup from the ED in the setting of "uncontrolled pain" (see previous column). Admission for "pain control" is a red flag for an underlying disorder that has been missed by the initial ED evaluation. In this case, the workup should have reasonably included a plain radiograph of the abdomen. This case was eventually settled on behalf of the plaintiff for an undisclosed amount.

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. Read past columns at ehospitalistnews.com/Lessons.