Complaint rebuttal and discussion
The defense asserted that Mrs. E.D. had severe COPD and pneumonia, and this was the source of her SOB and the underlying condition that caused demand ischemia. Defense experts further asserted that her severe COPD and pneumonia was treated appropriately and that there was little more that could have been done. Plaintiff experts disagreed and opined that had her true condition been recognized, additional therapies (such as beta-blockade, diuresis, intensive care) and monitoring (for lethal arrhythmia) would have been life saving.
Conclusion
Both hospitalists missed the ECG clues early in the hospital stay, and further misinterpreted the chest radiographs with respect to heart failure. Nonetheless, Dr. Hospitalist-2 was eventually dropped from the case as much of the criticism was focused on Dr. Hospitalist-1 and her failure to come and evaluate Mrs. E.D. on the day of her death.
During her deposition, Dr. Hospitalist-1 testified that she had no memory regarding the chain of events; however nurse depositions supported the notion that Dr. Hospitalist-1 never saw the patient even though she had written a full page of transfer orders. So regardless of the "battle of the experts," with respect to whether the demand ischemia could really have been treated or not, the case boiled down to a hospitalist who appeared lazy and uncaring.
The case was settled for an undisclosed amount on behalf of the plaintiff.
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.