A physician is sued, against the patient’s wishes:
You are the reason I am standing here today, the reason I’m not dead. I do not want you to be named in the lawsuit.”I thumbed through the chart, gathering my thoughts to come up with a careful answer. His words surprised me only a little, and I chuckled inside the way one does after locating a lost wallet only to find it empty. This is our world, and I have been around long enough to know that pulling out all the stops to save a life does not mean you won’t later have to face lawyers.
{ 13 comments… read them below or add one }
Does anyone here not see the difficulty here, (or outrage, if you will) is an insurer with the power to ovveride your medical opinion that this man needed an urgent MRI?
Why should he be processed through an ER for this reason? Is it not an uncessary delay involving addition wait and expenditure, dragging in a new set of physicians to to a redundant exam, to re-evaluate the same medical issue, review of signs and symptoms that has already convinced a treating physician that urgent MRI is necessary?
Why is there no mechanism for a treating physician in any office to order an urgent MRI, that doesn’t automatically excuse the insurer from paying?
The ER should but wont understand the urgency of the situation or the frustration and fear of the patient. So they screw up, in the way that a vacuum of information promotes. They don’t know that he’s already been where he should have gotten the MRI order, that he’s being jumped through hoops while terrified and in misery.
That patient did NOT belong in that ER. He belonged in a scanner ASAP, and the insurer’s demands delayed his care to protect the HERD, not that patient.
The headline is somewhat misleading, because the attorney needed his client’s permission to file suit against the doctor. I don’t doubt that the attorney wanted to review the records to see if there was any evidence of negligence on the part of the doctor, but it is quite likely that the attorney does that routinely in all such cases. In other words, it is possible that the attorney was just doing his job.
The patient was the one who consulted an attorney. What did he expect to happen? It is possible that he didn’t fully understand what he was doing, but I’m not sure you can blame that on the attorney.
Don’t shoot the messenger.
Yes, I’m a lawyer, in case you didn’t guess.
In any case, if what happened was documented in the patient’s records, it is difficult to see how such a suit would be viable.
The lesson is to always cover your ass (as if you didn’t know that).
Marilyn Mann
If an insurer does not respond without delay, with pre-auth, when any treating physician requests an urgent test, they should be estopped from claiming pre-auth was not obtained. It’s no one’s fault but their own if half the staff is on vacation.
At minimum they should be required to evaluate it on the basis of what they would pay for in an ED setting.
What should have been done is for his doctor to call the ER that he wanted the patient to be checked in as a patient and he, himself, would take care of the patient, not the ER doc, and order a CT of neck with contrast. The radiologist would see the abscess and he would recommend an MRI and the Neurosurgeon would want an MRI prior to surgery. This would have been more efficient and would not have caused any delay. Every party involved including the insurance company would be happy.
Or, just admit the patient directly from office. If a life threatening spinal abscess was at the top of this MD’s DDX, why mess with the outpatient work-up? Would have saved a lot of time and hassle.
This is another pitfall to the “outpatient” only doctor world. as a fp that still admits, I see op doctors ordering stat op tests when one can reasonably ascertain that the patient will need inpatient care. Medicare reimbursement/lack of respect in hospitals/lack of work ethic/etc have made this possible. Good primary care (inpt. including) that is adequately compensated to stay in such settings would have allowed this man to be cared for more quickly. Why lament about prior auth refusals when the ct scan stat in a hosp acute setting would have directed this better. OP only doctors lose this perspectiveat times because they have no control over the situation. However, this doctor was let down to some extent by his ED, and he should have directly communicated to the doctor there about his concerns.
A good reason to be selective about what plans, if you any, you sign on to.
this probably shows my ignorance, but why is a physician liable if they order a “stat” test and the insurance denies it? Shouldn’t the insurance company be liable since they disregarded the physician’s expertise that this test be performed? This is totally confusing to me.
The answer to “why” is too long for a blog–no one would read it–and involves a long series of court cases and legislation.
Bottom line, the medical care is the physician’s responsibility-period. No matter who else isn’t doing their job, or who in doing their job is obstructing things, it is the physicians ultimate responsibility to move them, run over them, or go around them..
Believe us when we tell you, that is the way it is. Frustrating it is, but all patients will rue the day when no one has the final responsibility for the outcome, when physicians, like everyone else, is responsible only for process and not outcome.
“The headline is somewhat misleading, because the attorney needed his client’s permission to file suit against the doctor”
Misleading headlines are Kevin’s stock in trade on this subject. He’s not really interested in objectively reporting the facts on this issue, as much as he criticizes all lawyers for doing the same thing according to him.
Do the attorneys have their own website? Because anon 3:11 needs to stick to them. The point of the matter is that the patient wanted to sue THE DENTIST and not to sue the doctor, yet the atty’s basically told the patient that he had to sue all. So exactly what is misleading? This patient/client wanted “justice” (as he saw it) from the dentist, and was “forced” by the atty’s to seek a suit against the doctor, against the client’s obvious wishes. Yes the client had to give permission, but with those conditions,the client had little choice. And please don’t argue the point that there is no case without filing against the doctor, because if that is the case then the atty’s should have just told the pt./client he had no case!
You glean all this from a newspaper article? You don’t need to see the pleadings or evidence?
Do you practice medicine this way? It’s amazing how doctors piss and moan about the poor quality of medical journalism (at least when it doesn’t beatify physicians), but think the media gets legal journalism right every time.
While I am familiar with the likely insurer in this case, and have absolutely ZERO good to say about them, I’d also toss out that this patient does have some responsibility here:
doc (with worried voice): “You need to go to the ER right now to get an MRI, you could die or be paralyzed if you don’t! You could have a life threatening infection or fast-growing cancer!”
pt: “No, if I go to the ER, I’m going to have to wait for five hours and I don’t want to do that.”
doc: “….?”
All this from a patient who came in demanding an immediate angiogram? Where did he think he was going to get *that* procedure, other than through the emergency department?
That moment of refusal to go to the ED was the moment where, in a fairer legal system, “loser pays” damages would have been triggered if this patient then brought a suit.