Foot "Sprain" Hiding Virulent Infection

On returning from a trip to the beach, a 65-year-old Rhode Island woman had worsening foot pain for a day before presenting to a hospital emergency department (ED). The PA who examined her diagnosed a foot sprain, and she was discharged. The PA's supervising emergency physician, though not consulted, later signed off on the patient's chart.

In actuality, the woman had a virulent strain of group A streptococcus, which was diagnosed when she returned to the ED two days later. Her condition did not improve, and she died after two days in the hospital.

The plaintiff alleged negligence in the defendant PA's failure to make a correct diagnosis at the first ED visit. The plaintiff claimed that a blood test should have been performed, as well as a re-check of the decedent's vital signs. The plaintiff also faulted the PA's failure to communicate with the defendant emergency physician.

The defendants claimed that the diagnosis of foot sprain was reasonable, and that the PA was qualified to make that diagnosis.

Outcome
A defense verdict was returned.

Comment
When an advanced practice clinician provides care that involves a malpractice claim, it is almost a given that a claim will be made against the supervising physician as well. It is these circumstances that highlight the importance of good communication and support between the two. The facts in this case indicate that the supervising physician signed off on the medical record but did not examine the patient. This is frequently the case in a busy ED, especially when the injury appears to be minor and no complicating factors are evident. The relationship between the two professionals allows the supervising physician to have confidence that the PA is able to make an appropriate diagnostic decision.

There is little in the history presented that would support a finding of malpractice. Pain alone would not likely lead to an alternative diagnosis of virulent strep A infection. Only when the patient returned were symptoms apparently present that led to the alternate diagnosis of a virulent strep A infection. Unfortunately, despite immediate and appropriate treatment, the patient died.

Every defense lawyer knows that defendants who blame each other hand the plaintiff a win. Fortunately, in this case the supervising physician supported the PA's decision making. Wouldn't it be better if each professional were considered individually responsible for his or her actions? I believe both patients and physicians would be better served in a system that recognized individual responsibility without reliance on the theory of supervisory liability. —JP

Cases reprinted with permission fromMedical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

On returning from a trip to the beach, a 65-year-old Rhode Island woman had worsening foot pain for a day before presenting to a hospital emergency department (ED). The PA who examined her diagnosed a foot sprain, and she was discharged. The PA's supervising emergency physician, though not consulted, later signed off on the patient's chart.

In actuality, the woman had a virulent strain of group A streptococcus, which was diagnosed when she returned to the ED two days later. Her condition did not improve, and she died after two days in the hospital.

The plaintiff alleged negligence in the defendant PA's failure to make a correct diagnosis at the first ED visit. The plaintiff claimed that a blood test should have been performed, as well as a re-check of the decedent's vital signs. The plaintiff also faulted the PA's failure to communicate with the defendant emergency physician.

The defendants claimed that the diagnosis of foot sprain was reasonable, and that the PA was qualified to make that diagnosis.

Outcome
A defense verdict was returned.

Comment
When an advanced practice clinician provides care that involves a malpractice claim, it is almost a given that a claim will be made against the supervising physician as well. It is these circumstances that highlight the importance of good communication and support between the two. The facts in this case indicate that the supervising physician signed off on the medical record but did not examine the patient. This is frequently the case in a busy ED, especially when the injury appears to be minor and no complicating factors are evident. The relationship between the two professionals allows the supervising physician to have confidence that the PA is able to make an appropriate diagnostic decision.

There is little in the history presented that would support a finding of malpractice. Pain alone would not likely lead to an alternative diagnosis of virulent strep A infection. Only when the patient returned were symptoms apparently present that led to the alternate diagnosis of a virulent strep A infection. Unfortunately, despite immediate and appropriate treatment, the patient died.

Every defense lawyer knows that defendants who blame each other hand the plaintiff a win. Fortunately, in this case the supervising physician supported the PA's decision making. Wouldn't it be better if each professional were considered individually responsible for his or her actions? I believe both patients and physicians would be better served in a system that recognized individual responsibility without reliance on the theory of supervisory liability. —JP

Cases reprinted with permission fromMedical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

On returning from a trip to the beach, a 65-year-old Rhode Island woman had worsening foot pain for a day before presenting to a hospital emergency department (ED). The PA who examined her diagnosed a foot sprain, and she was discharged. The PA's supervising emergency physician, though not consulted, later signed off on the patient's chart.

In actuality, the woman had a virulent strain of group A streptococcus, which was diagnosed when she returned to the ED two days later. Her condition did not improve, and she died after two days in the hospital.

The plaintiff alleged negligence in the defendant PA's failure to make a correct diagnosis at the first ED visit. The plaintiff claimed that a blood test should have been performed, as well as a re-check of the decedent's vital signs. The plaintiff also faulted the PA's failure to communicate with the defendant emergency physician.

The defendants claimed that the diagnosis of foot sprain was reasonable, and that the PA was qualified to make that diagnosis.

Outcome
A defense verdict was returned.

Comment
When an advanced practice clinician provides care that involves a malpractice claim, it is almost a given that a claim will be made against the supervising physician as well. It is these circumstances that highlight the importance of good communication and support between the two. The facts in this case indicate that the supervising physician signed off on the medical record but did not examine the patient. This is frequently the case in a busy ED, especially when the injury appears to be minor and no complicating factors are evident. The relationship between the two professionals allows the supervising physician to have confidence that the PA is able to make an appropriate diagnostic decision.

There is little in the history presented that would support a finding of malpractice. Pain alone would not likely lead to an alternative diagnosis of virulent strep A infection. Only when the patient returned were symptoms apparently present that led to the alternate diagnosis of a virulent strep A infection. Unfortunately, despite immediate and appropriate treatment, the patient died.

Every defense lawyer knows that defendants who blame each other hand the plaintiff a win. Fortunately, in this case the supervising physician supported the PA's decision making. Wouldn't it be better if each professional were considered individually responsible for his or her actions? I believe both patients and physicians would be better served in a system that recognized individual responsibility without reliance on the theory of supervisory liability. —JP

Cases reprinted with permission fromMedical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.