tag:blogger.com,1999:blog-7246437090183358425.post9149696112831676521..comments2023-05-11T05:09:56.981-05:00Comments on NY Emergency Medicine: Law and Medicine RoundsAdamhttp://www.blogger.com/profile/08610726909094095021noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7246437090183358425.post-20382615810992449482007-11-12T15:34:00.000-05:002007-11-12T15:34:00.000-05:00Something to keep in mind, from your last commente...Something to keep in mind, from your last commenter.Chrysalis https://www.blogger.com/profile/00757696627388704079noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-73847983804580407442007-10-27T22:58:00.000-05:002007-10-27T22:58:00.000-05:00NY is a one party telephone recording state. That ...NY is a one party telephone recording state. That means if you have a way of recording the conversation with the consultant, you may do so without notifying the consultant that you are recording. Email the conversation to yourself and append it to the chart as well as keeping it in your "trouble file." You do have a trouble file, don't you?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-24105238233553705052007-10-26T21:22:00.000-05:002007-10-26T21:22:00.000-05:00You are right, and the on-call surgeon was also su...You are right, and the on-call surgeon was also sued. I was focusing the discussion on the suit involving the emergency medicine physician. Regarding the emergency medicine physician, it is easy to see how you might feel that you have reached a "dead end" when the consult refuses to see the patient. Perhaps he would have had more success if he had called the chief of surgery.Dainiushttps://www.blogger.com/profile/00467646305198652055noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-9063503278841219462007-10-26T16:50:00.000-05:002007-10-26T16:50:00.000-05:00I think the on call surgeon should be the one sued...I think the on call surgeon should be the one sued. That sucks the attending didn't have the instinct to do more or try harder for this patient.NocturnalRNhttps://www.blogger.com/profile/14897522065495303540noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-47478210569745043972007-10-26T13:17:00.000-05:002007-10-26T13:17:00.000-05:00Wyatt, excellent comment and good pick-up. The th...Wyatt, excellent comment and good pick-up. The thoracic surgeon was sued as well. I just focused on the case involving the emergency medicine doctor. This was a much uglier situation for the surgeon. The surgeon's case did not appear to make it to court, either, which suggests that there was probably a settlement, a big settlement. Remember, this case was only to determine if a jury should hear the claim that the emergency physician was negligent. The judge initially threw the case out. All of the points you make would be in favor of the emergency medicine doctor and would be weighed by the jury. Nevertheless, the doctor pretty clearly transferred an unstable patient. This is BOTH an EMTALA violation as well as malpractice. That is, unless the emergency physician can truly convince the jury that there was no other option . . . which there might have been according to hospital policy.Dainiushttps://www.blogger.com/profile/00467646305198652055noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-73642423416804621132007-10-25T22:49:00.000-05:002007-10-25T22:49:00.000-05:00Was the on-call surgeon not sued (or at least fire...Was the on-call surgeon not sued (or at least fired) as well? I didn't think that hospitals were allowed to refuse emergency care to the uninsured. If they are, and that was the surgery department's policy, there's no reason to think that the chief of surgery would have acted differently. It seems to me that the ER doc didn't really submit to a "dead end" -- he arranged for emergent transfer of the patient rather than admitting him with conservative management. If he thought the patient was stable enough for transfer, then the question is less should he have contacted the chief of surgery which would have been time consuming in its own right, than was his judgment on the patient's stability negligent or not.Wyatthttps://www.blogger.com/profile/18167258722400122642noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-53230544717957603312007-10-22T13:09:00.000-05:002007-10-22T13:09:00.000-05:00Your point is a good one. Under the stress of the...Your point is a good one. Under the stress of the situation, the emergency medicine physician may not have considered calling the chief of surgery to summon another surgeon for the thoracotomy. It was not clear how well the policy was understood in this case, but apparently the hospital had a written policy that if a consultant can not be obtained, the chief of service should be notified. The emergency physician claimed he was not familiar with that policy. <BR/><BR/>Regardless, when our effort to provide a patient with a necessary intervention seems to fall victim to hospital "sabotage," we must consider other ways to reach our goal within our own hospital. In this case, it may have been reaching the chief of surgery. In another case, it may be bypassing the initial intern or resident on call. We should try not to throw up our arms when we reach a dead end consult. Of note, this case never made it to a jury, which indicates that the parties may have settled.Dainiushttps://www.blogger.com/profile/00467646305198652055noreply@blogger.comtag:blogger.com,1999:blog-7246437090183358425.post-86553143360141269742007-10-21T21:16:00.000-05:002007-10-21T21:16:00.000-05:00Seems like a pretty high standard they're setting ...Seems like a pretty high standard they're setting for the physician. Even incorporating the knowledge of a physician into the reasonable person standard, should we expect "thinking outside the box" in an emergency situation? What might seem like a simple solution to someone presented with a neat set of facts and unlimited time to think about it is not necessarily going to occur to someone in the middle of a trauma.isleshttps://www.blogger.com/profile/02590214024734692552noreply@blogger.com