The Court of Appeals of Indiana (“Indiana Appellate Court”), in its February 21, 2020 Memorandum Decision, upheld an Indiana medical malpractice jury’s defense verdict in a case where the ER doctor interpreted a patient’s chest x-ray as normal and later a radiologist interpreted the same x-ray as showing cardiomegaly (an enlarged heart). The patient died 24 days after his ER visit due to “Suspected Cardiac Arrhythmia,” “Artherosclerosis of Coronary Arteries,” and “Marked Cardiomegaly With Left Ventricular Wall Thickness.”
The Underlying Facts
The 52-year-old, 377-pound decedent, who had a history of hypertension, went to the ER on October 3, 2000, with complaints of chest and abdominal pain that had started the day before while he was working on a deck at his house. The ER doctor ordered an EKG and lab work, the results of which she interpreted as normal. The ER doctor believed that the decedent’s pain was confined to his chest wall and stated in the discharge instructions: “It appears that your chest pain today is due to a problem confined to the chest wall, and is not in your lungs or heart” The discharge instruction further stated, “FOLLOW UP WITH FAMILY DR IN 2-3 DAYS.”
The discharge instructions also stated, “If you had x-rays completed, they will be reviewed by a radiologist. If his interpretation is different from mine, we will call you as soon as possible at the number you gave to the registration clerk.”
A radiologist reviewed the chest x-ray and determined that it showed cardiomegaly. Copies of the radiologist’s report were sent to the ER and to the decedent’s family doctor, but according to the plaintiffs, no one from the hospital contacted the decedent to tell him about the finding of cardiomegaly. No evidence was presented during trial as to whether the decedent did or did not follow up with his family doctor, as he had been instructed to do.
Witnesses testified during trial about the hospital’s process for dealing with discrepancies between an ER doctor’s interpretation of an x-ray and a radiologist’s interpretation: If the radiologist’s interpretation differs from the emergency medicine physician’s interpretation, the radiology department will send a copy of the radiologist’s report to the emergency department and the emergency medicine physician on shift at the time the report is received will review the report. It is the emergency medicine physician’s determination whether the discrepancy and the radiologist’s read of the report is significant enough to warrant contacting the patient. If the emergency medicine physician determines that no change in treatment plan is necessary, then a supplemental report will not be completed as no further action or treatment is deemed necessary. The only time that a supplemental record is created is if the emergency medicine physician determines that a significant discrepancy exists warranting a change in the treatment plan for the patient. In this instance, a supplemental record will be completed, and the emergency medicine physician will direct the charge nurse to have the emergency department contact the patient to advise them of the change in care plan.
The Indiana medical malpractice wrongful death jury returned its verdict in favor of the defendants, and the plaintiffs appealed.
Indiana Appellate Court Opinion
The Indiana Appellate Court stated that the ER doctor who reviewed the radiologist’s report pursuant to this procedure has never been identified. However, there is no supplemental report, which indicates that this second ER doctor did not believe the radiologist’s finding of cardiomegaly constituted a significant discrepancy that necessitated a call to the decedent. The Indiana Appellate Court further stated that the defense also presented substantial evidence that the second ER doctor was not negligent in concluding that there was no need to call the decedent.
The Indiana Appellate Court stated, “To be sure, the failure to call was a breach of the discharge instructions. However, that does not mean it was a breach of the standard of care … the defendants presented extensive expert testimony that the failure to call, under the specific circumstances of this case, was not a breach of the standard of care, regardless of what the discharge instructions said.”
Source Doll v. Kester, 19A-CT-663.
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