Man sues hospital for a "forced" rectal exam

in Uncategorized | 42 responses

In cases involving trauma, a rectal exam is one way to assess for neurological damage. In our malpractice-mad society, this resulted in a frivolous lawsuit:

A construction worker claimed in a lawsuit that when he went to a hospital after being hit on the forehead by a falling wooden beam, emergency room staffers forcibly gave him a rectal examination . . .
. . . says in court papers that after he denied a request by NewYork-Presbyterian Hospital emergency room employees to examine his rectum, he was “assaulted, battered and falsely imprisoned.”
His lawyer . . . later learned the exam was one way of determining whether he had suffered spinal damage in the accident.

Comments

ERMurse
Pretty standard protocal in most Trauma centers with Trauma patients is after the initial ABC’s exam to log roll the patient off the backboard, feel down the back and usually with no warning, and rarely with consent, stick a finger in their rectum to test the “nerves” and check for blood. Its part of Trauma Dogma that the rectal get done but I havent seen anything in the way of evidence that a less invasve ineuro exam is not just as good for checking neuro status. We called it the Trauma Team handshake. One Attending on the team used to say the only reason you dont do a rectal on a Trauma patient is if the pateint does not have a rectum or you dont have a finger. Good, its about time they get sued for these forced rectals.
alexa-blue
“Conclusion
The digital rectal examination has poor sensitivity for the diagnosis of spinal cord, bowel, rectal, bony pelvis, and urethral injuries. Our findings suggest that the digital rectal examination should not be used as a screening tool for detecting injuries in trauma patients.”
Anonymous
This is complete bs. If you are going to be cared for in a trauma situation you can’t pick and choose what you want done. This is a package deal. Either we help you or we don’t, but we don’t handicap ourselves we it comes to making sure that people aren’t injured and need immediate help. Complete bs!
Anonymous
This fine gentleman and this very same distinguished counsel would have sued of course if this rectal HAD NOT been performed and there was spinal damage. And won big time in a heartbeat.
Just the usual jackpot justice roll of the dice.
Ed Sodaro MD
Anonymous
Doctors, you are full of nonsense. A patient CAN pick and chose which procedures s/he will consent to. That’s the basics of informed consent.
Any intrusive touching without consent is criminal assault and battery as well as a tort.
No means no–whether it’s sex or a medical exam.
This is not a “frivolous” suit; it aims to protect the basic rights of a free society: bodily integrity.
That you doctors are so ignorant of the law of informed consent is truly distressing. I’d only go into a hospital with my gun (you have a right to self-defense to protect yourself from assault and battery . . .)
Anonymous
Can a patient with head trauma be expected to give informed consent? Sometimes, doctors don’t have that luxury and have to act in the patient’s own best interest.
Anonymous
3:42, you are an internet nutter.
In a trauma resuscitation and evaluation, the consent is implied. If you don’t agree, don’t get in the ambulance and don’t go to the hospital.
The trauma room isn’t your private doctor’s office and you don’t have an unlimited right to decide what will and won’t be done to you there unless you check out AMA. And if you are intoxicated or are behaving unreasonably and are screaming “don’t touch me” at the top of your lungs, the staff do not have to follow your instructions on how to evaluate you or how to practice medicine in any other way.
Let this guy sue. He’ll lose and he should. I hope the “counsel” gets hit with defense costs.
Anonymous
“In a trauma resuscitation and evaluation, the consent is implied.”
Uh . . . you should talk to your hospital counsel. Consent is ONLY implied if the person is unconscious/ unable to give consent.
This pose is truly shocking in the ignorance it reveals about what doctors know about the law that regulates their behavior.
As I said, go to the hospital, bring your gun
Anonymous
Only lawyers should be allowed to do forcible rectal procedures to the innocent! This is a simple turf war
Anonymous
This is common practice and it is just part of trauma practice. This is patient empowerment taken too far. Should the nurse and physician have to check with delirious hurt patients before they do anything. Where do you draw the line. This rectal examination literally takes 1 second and yields useful information. I see money in this patients eyes. This is standard of care!
He would probably be sueing if they didn’t do the test too.
Anonymous
Should the nurse and physician have to check with delirious hurt patients before they do anything.
Was the guy in the article delirious? Doesn’t seem so.
Where do you draw the line.
When the guy is conscious and talks coherently?
IMHO, the guy shouldn’t have made a fuss and let doctors examine him. But… this doesn’t negate the fact that if a conscious patient in a right state of mind has a right to refuse a medical intervention.
Anonymous
..”Uh . . . you should talk to your hospital counsel. Consent is ONLY implied if the person is unconscious/ unable to give consent.”
You are obviously not in this business. I am and I know.
So, . . . uh yourself.
Consent is not implied only in cases of unconsciousness. There are many more circumstances where consent is implied: minority age, delerium, intoxication, dementia, psychosis or arrest (legal, and cardiopulmonary, obviously.)
If you are suspected to have sustained neurological trauma, you are not considered capable of making informed consent until you are examined and found to be neurologically intact. That can take a few minutes or a few days, it depends. Refusing that examination would not be considered a rational request.
Any idiot who can find a billboard lawyer can sue. So what. This “counselor” will not find a respectable witness to testify in his favor. He will find an army of experts to oppose him.
I doubt this case never sees court or a settlement.
Anonymous
This type of flamingly frivilous jackpot justice lawsuit against a TRAUMA UNIT does enormous evil. The case has absolutely no merit.
However, this is precisely the kind of outrageous explotative lawsuit abuse that makes it impossible to get decent specialists, or any specialist, to come to the ER.
If there were any justice, the crooked shyster would be disbarred, and the plaintiff would be made to pay every penny of defense costs.
Anonymous
I don’t think that we know enough from the article to know if the case has merit–unless we believe that no patient would ever have the right to refuse which is ludicrous.
We just don’t know what mental status he had presented up to that point. We what they did to get his consent. Did they explain? We also don’t know what the real risk was. Risk/benefit calculations apply to everything in medicine. There are no absolutes–anyone who thinks there are doesn’t have the judgement to do clinical work. What is the risk of not doning the rectal vs the risk of injury in holding down a refusing patient to do one?
I had a head injury requiring sutures in the ER a couple years go–no LOC–and I don’t think my friend did any neuro exam beyond noting my gait and motion as I came to the suture room and chating with me while he placed the sutures–and I don’t think he was negligent–just exercising good clinical judgement—something which protocols are the enemy of.
What is really disturbing is the arrogance assumption of power and virulent vitriol displayed here. This used to be a profession of gentlemen. Now it is increasingly more technicians than professional and rarely gentlemen.
ruby dee
What if this patient were a woman and you felt a pelvic exam was necessary to evaluate a head wound, would you ignore her protests and get 5 people to hold her down while she was screaming for you to stop? It’s a no brainer. The hospital would be calculating settlement figures before the dust settled.
Anonymous
If our society is “malpractice-mad”, how come the vast majority of malpractice goes uncompensated? Most victims don’t even make claims.
The facts seem to always give Kevin trouble.
Anonymous
“If you are suspected to have sustained neurological trauma, you are not considered capable of making informed consent until you are examined and found to be neurologically intact. . . . Refusing that examination would not be considered a rational request.”
Uh no. Competence is never presumed to be absent. As a matter of law, individuals who appear normal, respond to questions, etc., are assumed to be competent for informed consent purposes.
Again, the doctors’ ignorance is astounding. This is NOT a frivolous law suit. If you read the article, you’d know that the plaintiff survived initial motions to dismiss. It only a BS lawsuit in the eyes of doctors, not the law as it embodies the judgment of society.
WHy did this case survive motion to dismss? Because physical integrity is essential to a free society . . . no means no.
As for not being “rational” to refuse a rectal, the initial posts point out that there may be no evidenced based rationale for the rectal. Uh . . . I think all patients have the right to demand that ONLY evidence based procedures be applied. Otherwise, medicine is just voodoo. Further, it’s a rectal is a form of anal rape–is it “rational” to wish to avoid anal rape.
That leaves up with a question. Why are apparently so many doctors so worked up about this? It could be that many are repressed homosexuals and may enjoy their rectal probes?
More likely, given the number of nerdy, geeky people who become doctors and no doubt are little powder kegs of resentment acquiried since elementary school, doctors cling to the rectal probe as part of their need to demonstrate dominance.
Let’s see how the trial turns out. Our liberties are on the line.
Anonymous
Having once saved my own life by refusing a misguided treatment, I abhor the notion of implied consent. On the other hand, a rectal exam is not a risky procedure. This is a frivolous case.
Anonymous
8:32, your shrillness does not make you more persuasive.
A rectal exam is not “anal rape”, no matter how hopeful you might be in trying to paint this case with the broad and mindless brush of sexual violence.
A rectal exam in a trauma setting has utility in determining intactness of the lower spinal cord. Its importance will not be upended by a poll of the posters on this blog site, no matter how badly they might like to think their non-professional opinions should matter. The relevant components of a neurological exam are not determined by a vote of blog lurkers. And your the idea that personal liberties are at stake in this ridiculous case is just laughable.
Surviving initial motions to dismiss is regrettable but does not make a case. Lots of judges let meritless cases go forward; that does not mean the case has merit; it may have merit by being defeated at trial.
And as for repressed homosexuals, –or more properly homosexual panic–the individual most suspect here is the plaintiff. Trying to paint doctors, for whom you should know this kind of examination is no source of pleasure, as actually enjoying this kind of procedure just shows how little you know of the trauma care environment and the circumstances where this is done. Believe me, if there was a better way to check sacral nerve integrity in trauma evaluation, rectals would be a thing of the past.
The person posting above who brought up the pelvic exam obviously does not understand the medical reasons for the rectal, or the issues in this case as pertains to the actions of the ED staff. You don’t need to do a pelvic exam to clear the lower spine by examination.
What the non-medical rights enthusiasts here don’t get is that when a patient has to be cleared of spinal injury, the examination requires thoroughness. You can’t simply vote out the parts that make you squeamish, or embarrassed or uncomfortable; that goes for the doctors doing the exam and the patients having the exam. How you feel about having the exam has no bearing on how important that exam is. Funny thing, objective reality.
And no one says you have to go to the hospital (unless the cops take you there, then I guess you don’t have the choice.)
Anonymous
Hmmm . . . I think the doctor protests too much. . . maybe the doctor does find some power/sexual thing in doing these exams.
Regardless, I think my points stand.
One last thing
“What the non-medical rights enthusiasts here don’t get is that when a patient has to be cleared of spinal injury, the examination requires thoroughness. You can’t simply vote out the parts that make you squeamish, or embarrassed or uncomfortable”
Notice you ignore the interesting posts suggesting that rectals are not evidence based.
But, even if they are, patients have a right in determining what procedures they go under. PERIOD. If you believe that creates, “unthorough” exams, note it on your chart and move on. Do your best given the parameters your patient/customer has given you. When patients go the emergency room, they do not loose the right to chose and control their bodies. That you believe otherwise is, as I said, very disturbing.
Let’s hope this guy gets a big settlement–maybe the doctors will then learn the law.
Anonymous
Meh. Another reason I will never take ER call. Apologies to the normal people who won’t get the specialist they need. A tip of my cap to the tin foil hat wearing crowd on this thread, who undoubtedly will be relieved to learn have no fear of being assaulted with consults by orthopedic surgeons, plastic surgeons, ENTs or urologists.
ERMurse
The Rectal as a mandatory Trauma exam for anyone who gets seen by the Trauma service or goes into the Trauma room wether you need it or not wether you consent or not is a hot topic between Nursing and Surgery and Emergency Medicine and Surgery. Lets get back to basics, The procedure has not been shown to be sensitive in numerous studies but Surgery hangs on to it. Its not the only test of lower spinal cord function available. And patients do not become incompetent to consent because they qualify to be seen by the Trauma Service. My experience is the vast majority are alert and competent. I wish the suit success.
Anonymous
The only thing I object to here is the characterization of “society” as “malpractice mad”.
Seems to me if that were true I’d know at least one person who filed such a suit. I do not.
But I do know several people who have lost access to physician groups because they voiced concerns about treatment — you know, the same stuff you discuss here, taking action to limit the unnecessary “defensive” testing.
Based on that, I’d have to conclude that patients are in more danger of being shafted by modern medicine that doctors are of ever facing a lawsuit.
Happyman
ERMurse: just because a test lacks sensitivity, that doesn’t mean it shouldn’t be done, especially in a trauma situation.
In fact, probably MOST tests that are done in an ER lack sensitivity, but for the 1/1000 times the test is positive (ie. lack of sphincter tone in this case), outcomes can be changed dramatically with that information. It is the SPECIFICITY that is important here – if there is either a lack of tone, or blood on the glove, very useful information is gleaned.
Talk of sensitivitiy & specificity apply more to outpatient management of chronic disease & non-urgent complaints. For example, there generally is little utility to getting a head CT for a chronic headache that seems like a tension headache. But for someone who comes to the ER with acute-onset frontal headache, they will often get a ct, mri, and or neuro consult. Usually this will yield a negative result (hence the low sensitivity).
The pan-scan, cxr, & chem-20 that goes with every elderly patient in an ER also has very little sensitivity. But it is done because their presence in the ER deems them to be emergent.
If nursing depts want to argue with surgeons & ER docs as to which tests are necessary and which are not, then they should a) go through the YEARS of schooling / residency to become a licensed MD; and/or b) assume the same degree of liability as the ER doctors.
I weep for the future of emergency medicine, & medicine in general. When those IN the field don’t get it, what hope is there?
ERMurse
So here we go again with the Nurse don’t question the Doctor unless you go to medical school and walk in my shoes. Sorry, the role of the Nurse is an advocate for the patient first. Its in nearly every State’s Nurse Practice act. Questioning the Doctor is the core of my job as a Nurse, especially in a teaching hospital where there is a locker room mentality in the Trauma room. I do agree your argument on that a lot of testing in the ED is of low sensitivity. But very little of the typical ED workup is forced and as invasive as a unannounced finger up your butt and if you resist having the Trauma service henchmen (PG1′s and PG2′s on the service) hold you down while the Trauma resident doing the exam forces your cheeks apart to test your tone. Its almost as bad as the forced Foley catheter that usually follows the forced rectal exam by a few minutes. At the Level I trauma hospital that I have spent many years working the EM Physicians were just as opposed to the practice of the forced rectal on competent patients so this is not a Nurse Doctor argument. It’s a Trauma Surgery – Everyone else argument and a glaring example of arrogant behavior. I’d rather see this patient make a complaint to the State Licensing board against the license of person performing the exam and perhaps a criminal complaint for assault and battery rather than sue and take a settlement which does not change behavior. Any finincial damages should come from the Hospital that allows the practice to continue.
Anonymous
ERMurse, if what you write is an indication of your view about the work of your emergency department, then I have doubts about your fitness for nursing. You seem to have an oppositional attitude toward doctors, and your claims at being motivated by patient advocacy is unconvincing, more a sublimation of your root hostility. Sadly, that seems to be common in nurses.
You have appropriated superficial reasons for objecting to physical examination–here, low sensitivity of a rectal exam in an ER trauma assessment–without offering any example of a meaningful alternative. Does that mean you propose no alternative? I find that a casually easy and self-righteous position to take, but maybe that is to expected from someone who really doesn’t have to bear responsibility for omission of critical examination findings or diagnoses in injured patients.
You pretend to be in the game, but you criticize from the sidelines.
Anonymous
Setting aside the issues that as a layperson I don’t understand, and looking from common sense, logic point of view, I see a gap in logic of this case.
1. If the guy is incompetent because he had a head trauma, then he shouldn’t be held responsible for accidentally hitting someone when resisting the procedure he didn’t want. Why did they put him in jail and filed charges against him?
2. If the guy is competent enough to be responsible for his actions, how come he is not competent enough to give informed consent?
Additionally, it is not clear if the purpose of the test was explained to him.
Anonymous
The rectal exam is generally a low yield test but absolutely critical when the chart is examined with the rectrospectoscope.
I do a rectal examination on all lawyers no matter what their chief complaint is to show they are:
1. Neurologicaly intact. (However this is difficult when so many have loose tone in this patient cohort.) It is best to do this in front of the whole medical team so you can’t be accused of not doing it. This includes the bulbocavernosis reflex — if you can find the penis somewhere within in the jiggling rolls of fat.
2. There is no rectal mass (not placed there on purpose that is)
3. No occult blood — key documentation for virtually any chief complaint.
Anonymous
I don’t get all the docs that still say they do this exam as common practice. The second comment points to a study showing this exam basic has low sensitivity for all the things you think it’s good for.
In other words, you might as well insist on mumbling “Oooglie Booglie!” and get similar results.
When docs start ignoring the research because “they know better,” that’s a clear sign of ignorance and tradition winning over rationality and data.
Ten years from now, nobody will be doing digital rectal exams anymore in trauma, because they stink for what they’re supposed to measure.
Anonymous
It may have low sensitivity, but it has fair amount of specificity. It may not be a perfect test, but it gets the job done and it gets the job done fast.
I am sure we could probably wheel in an some machine somehow to look at nerve function and have near perfect sensitivity, but that is expensive and time consuming.
The same people on this board who are complaining about rectal exams are the same people that lament how much the ER costs, yet they don’t want cheap screening tests. They only want the ones that are the gold standard and they want it STAT! OH yeah, and they don’t want to pay any more for the gold standard and speed. Give me a break.
Mike
A rectal exam takes two seconds, it’s only mildly uncomfortable, and there’s no lasting damage. Anyone who wants to bellyahce how the guy is “scarred” mentally (probably cultural, right?)and his rights were violated is a whiner, the kind of person who wants general anesthesia for a cavity.
As long as the sensitivity is greater than zero, its worth doing. It is not “invasive”. There’s no blood loss, its fast, and you can directly check several organs, no incision is made. If a nuerologist jabs a sharp ended stick to check your sensory tracts, would that also be a battery?
Why is there no priority given to true injustices in medicine and society in general? Is this event truly worth 26 million dollars? Doesn’t anyone have any sense? For any doctor or nurse who has “been there”, it’s a no brainer.
Anonymous
I don’t think the issue here is rectal exam and whether it is needed as much as that of informed consent and if the guy was competent enough to give it. BTW – a question to the doctors. Why did he wake up with a tube in his throat? If they wanted to sedate it, couldn’t they have done so without it?
Sure maybe he shouldn’t have refused. But he did. The issue here if he was competent to do it or if his head trauma rendered him incompetent. As I pointed in a couple of posts above, the doctors who accused him of assault thought he was competent enough to be responsible for it. How come the same doctors thought that he was not competent to refuse a test?
I think in this era of defensive testing, the issue of whether or not we have a right to refuse a test when we come to the ER – provided we are in the position to do so – is a whole lot more important than whether or not rectal exam is needed in this case. Because if we can be forced to have a test that is needed, we may also be forced to have a test ordered solely for defensive purposes and than made to pay for it. If the guy was incompetent it is another matter entirely.
Anonymous
All patients in head trauma situations are evaluated for alertness and orientation–competency. If he was competent and had refused the rectal examination–all the hospital had to do was present him with a form to opt out and the hospital would not be held liable. Forcing a rectal exam on an oriented person is illegal.
Anonymous
>>”Forcing a rectal exam on an oriented person is illegal.”
That might be your personal opinion, but I very much doubt a court will find that anything illegal occurred or that the patient suffered compensable harm.
If for no other reason the argument of the greater public good can be made that emergency medical personnel should not be required to parse the elements of a comprehensive neurological examination done in a trauma care setting vis-a-vis consent and to have to decide whether each patient is competent to decide–rationally or not–whether particular steps in an examination can be done. Needing to clear a patient’s spine of injury in an acute setting requires respecting the timeliness with which that assessment must be done. It just isn’t practical to stop everything in a trauma code to go fetch release AMA forms so a patient can opt out of the rectal.
If this court is finding reasonably, then they will likely find that if you come to the hospital in a c-collar and on a backboard, then you have de-facto consented to whatever assessment is necessary to get you safely out of those devices. That goes for rectal exams, CT scans and any other reasonable examination techniques.
If our society wants an effective medical response to trauma, a balance of interests will have to curtail the notion of unlimited right to refuse evaluation so that first responders and ED responders can do their jobs without fear of unreasonable litigation.
Anonymous
If this court is finding reasonably, then they will likely find that if you come to the hospital in a c-collar and on a backboard, then you have de-facto consented to whatever assessment is necessary to get you safely out of those devices.
Did he come on a board and in a c-collar? The article didn’t say he did. Again, if he was incompetent, why did they jail him for resisting the test? Either he is competent or not, you cannot have it both ways.
Anonymous
The emergency room staff performing the medical evaluation didn’t arrest and jail the plaintiff, and the police, who presumably arrested the patient did not perform the exam the patient objected to. There is no inherent inconsistency here. The police apparently were not deferring to the ED doctor’s judgment about whether the patient should be arrested, and there is no reason to suppose they should have.
The doctor believing the patient is not rational to make consent decisions has nothing to do with the policeman trying to decide whether the assaultive patient is dangerous. Two different people looking at the same person for two different reasons, so your question is pointless.
The story does not say what sort of devices were brought with this patient; but paramedics usually bring trauma victims in in immobilizing devices, and those devices are usually not removed until after a physical examination of the patient is done and sometimes not until after a CT is done as well.
Anonymous
“The emergency room staff performing the medical evaluation didn’t arrest and jail the plaintiff, and the police, who presumably arrested the patient did not perform the exam the patient objected to. “
Is police generally present in examinations rooms in the ED and watches examinations? Or was it someone from the stuff who actually did the examination who called the police and pressed charges?
There is no inconsistency. Unless policeman was there in the emergency room and reacted on his own accord, it was someone who did the examination who choose to call the police and press charges.
Jeremiah
According to Brian Persaud himself, he was driven to the emergency room,simply to get stitches. Brian Persaud is a credible man. I Have seen and heard him in interviews, and I believe him. Patient advocate, Art Levin, believes him too.
A competent person can refuse treatment, even in an emergency setting. Hospital records describe Persaud as ‘alert and oriented’.
Don’t dismiss this case. It won’t be decided by doctors. I once sat on a jury in a malpractice suit. There was zero sympathy for the doctor, and the hospital involved.
It wouldn’t surprize me to see a settlement, before trial. that is Less risky for Cornell. You cannot second guess what a jury will do.
Persaud’s lawyer is hardly an ambulance chaser. He has represented Mafia figures, and got them acquitted. Beating the feds isn’t that easy.
Since my dad is a personal injury attorney, who has won many malpractice suits, I can say this.
High dollar attorneys do not pursue this kind of case, for five years, unless they have a great deal of confidence in winning. The hospital was hoping it would be dismissed. It wasn’t. We shall see. Never bet against a really smart lawyer. Remember Johnny Cochran.
Anonymous
Regarding the study showing the rectal exam is not useful…just because someone can pop onto google and find a result (and I doubt anyone read more than the title or a few lines in the abstract), doesn’t mean the study is significant. As a researcher, I don’t rely on a single result, but rather a collection of results, each of which I critically assess, to come up with a conclusion. I doubt most people commenting on the “effectiveness” have read the quoted article itself, or any of the cited articles (which argue both for and against the use of the exam).
Basically, the doctors were trying to perform a reasonable test that might indicate a larger, more life threatening problem. I’m happy the courts saw that the doctors were trying to perform a thorough diagnosis/treatment on their patient.
Rusty
Some pretty disturbing responses, seemingly down the medical line. Meds on the “Do it” and civilians on the “We have rights”. As a person with specific religious beliefs I can ssure you that many people have many reasons for denying consent to certain procedures. The guy was not in a coma and the fact he refused consent after being told what they wanted to do shows me he was not in a position to be deemed “incapable of making decsions about his person”. I as a concious and lucid person have the right to refuse any tests I so choose, that is MY right and medical “professionsals” have a concrete “Butt cover” in that cute little AMA form they have a patient sign when they refuse any part of, or request, by the medical staff. He wasn’t offered that option. He was assaulted and I would be enraged. The only persons creating this “us verses them” mentality are the medical professionals themselves who refuse to stop treating patients like animals who are visiting a vet. Just because you are a Medical Heath Care worker does not mean you can view people who come to you for help to be but dumb animals with no right to control their own person.
I as a patient have the responsibility to listen to your “Suggested courses of action” and any tests you would “like” done or think would help. It is then totally 100% up to me which tests I consent to and it is my responsibility to deal with the reprocussions. I sign your form, do the tests I will consent to, and take the help you offer. You give said help and do your best. That is the way it is suppose to be…equal respect.
Anonymous
This story is yet another reason why I hate hospitals, distrust doctors and nurses. If a patient says NO to anything (such as rectal exams, catheters etc.) then have him or her sign a release and or waiver of responsibility and let him go. I so loathe the “Medical Profession”. What a dispicable thing to force on anyone capable of deciding no. Whatever happened to patient rights? Doctors humph, God I hate ‘em all!
GG Freeman
Anonymous 8:35 – I hope you’re never in a serious trauma situation. The cops and medics who will risk their lives standing in traffic to scrape you off the road and bring you to the ER where the doctors and nurses just had a gun pulled on them for not seeing somebody’s dad fast enough for non-cardiac chest pain will still do their best to make sure you get the best care available. Heck, they will even save your life without so much as a please or thank you.
When I was an MS3, my VA attending had a rule: A rectal on every admission. Why? He had once missed a neurological injury that could have been caught with one.
Yes, patients have the right to refuse… and sure, if the plaintiff was competent at the time he can leave AMA.
BUT…
Anyone who will swing at you in the ER is baseline unstable. Period.
I know too many ER doctors, nurses and techs and clerks who have been assaulted because, “Mister Jones was angry and upset.”
Truly defensive medicine is when somebody has your 5’2″ nurse by the throat against the wall…
Anyone who thinks this guy should win his case… should be ashamed. You just said it’s ok to assault the very people (from the cop and medic to the nurse and doc) who put their lives on the line for you every day they walk into work.

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