Someone forwarded my the link to this story about a Connecticut woman who filed a multi-million-dollar lawsuit against a hospital and emergency physician for failing to diagnose pulmonary emboli which ultimately killed her husband.
According to the article, the patient went to Stamford’s Tully Hospital emergency department complaining of flank pain. The emergency physician performed a CT scan on the patient’s abdomen “without performing further testing” and then discharged the patient home.
Nine days later, the patient returned to the emergency department in critical condition with blood clots in both lungs. He died the following day.
It is hard to comment specifically about the case without knowing more facts. However, in general, pulmonary emboli are notoriously difficult to diagnose. We do a lot of chest CT scans looking for them, and a vast majority of the time the chest CT scans come back normal. Of course, after the negative result is known, then everyone accuses you of ordering an “unnecessary test” to look for a pulmonary embolism, but that’s another topic for later discussion. So in a patient who comes to the emergency department complaining of flank pain, a blood clot in the lungs is probably not going to be near the top of any reasonable physician’s differential diagnosis list. Flank pain is usually due to kidney problems and the kidneys are in your abdomen at about the level of your belly button. The pulmonary emboli that kill people lodge in the central parts of the lungs, in the center of the chest just to the sides of the heart. See the diagram.
The thing that really bothered me about the article was that the plaintiff’s attorney, Craig Yankwitt, from the Stamford law firm of Silver Golub & Teitell, was quoted as saying:
“They were simply not permitted to discharge without ruling out whether he was suffering from a life-threatening condition.”
This is ridiculous confabulated unsubstantiated calumny. And the purpose of this calumny is to try to bolster the retrospective claim that Mr. Yankwitt will try to use to make millions of dollars:
“Had they performed the additional testing, Mr. Hermann would still be alive.”
There is no rule that a physician or hospital is “not permitted to discharge” a patient without ruling out whether the patient is suffering from a life-threatening condition. To require so would demand perfection in medicine: Doctors are not allowed to miss any life threatening conditions ever, regardless of how obscure or tangential the complaint. Think about if this really were the case.
You come to the emergency department with pain when you urinate and a little bit of blood in your urine. Sounds like a simple UTI … but wait, we are “simply not permitted to discharge you without ruling out whether you are suffering from a life-threatening condition.”
Your could have a pulmonary embolism. That is a life-threatening condition. According to Mr. Yankwitt, you can’t be discharged until a pulmonary embolism has been ruled out. We’ll have to do a CT scan of your chest before you can be discharged.
Kidney cancer is also a life-threatening condition. Add a CT scan of the abdomen and pelvis to the list of tests.
And you *could* be suffering from brain cancer. That’s a life-threatening condition. According to Mr. Yankwitt, you can’t be discharged until that potential life-threat is ruled out. May as well do a whole body CT scan and get it over with.
But wait, you *could* also be suffering from leukemia. That’s a life-threatening condition. We’ll need to get an oncology consult for a stat bone marrow biopsy just to “rule out” that life threat.
You could also have been poisoned by some unknown chemical. We should probably draw a few dozen tubes of blood and send them to the Mayo Clinic to rule out every possible poisoning “life threat.” Been exposed to any strychnine lately? We’ll have to test for that before we’re “permitted” to discharge you. Looks like you’ll be in the emergency department for a while until the tests come back.
Oh, and you *could* be suffering from a Naegleria fowleri infection. That’s verylife-threatening and it doesn’t show up on CT scan. We’ll call the neurosurgeons for a stat brain biopsy as soon as the oncologists are done with you.
By this time, we’ve increased your risks of cancer from all the extra radiation, have increased the risk of a bad outcome from performing surgical procedures, have left a hole in your brain, and have caused you to incur tens of thousands of dollars in extra testing … and we haven’t even scraped the surface of all the “life-threatening conditions” that we allegedly must rule out before we are “permitted” to discharge you.
According to plaintiff attorney Craig Yankwitt’s logic, we’d have to do this testing on every person who comes to the emergency department – even if it was for a hangnail – because we are “simply not permitted to discharge without ruling out whether [patients are] suffering from a life-threatening condition.”
When you wonder why physicians perform low yield testing and why defensive medicine abounds, think of plaintiff attorneys like Craig Yankwitt who perpetuate medically unjustified myths and who use hindsight bias as a means to become wealthy.