Hospitalists, going through the motions, and medical malpractice

I spent most of the day today taking the depositions of two defendant hospitalists who were involved in the botched medical care provided to my client.

A defendant’s deposition is an important part of any Texas medical malpractice case. It is the only pre-trial opportunity that a plaintiff’s attorney has to ask questions directly to the defendant in advance of trial. The witnesses are sworn in by a court reporter, who then transcribes every word said of the questions and answers. The testimony may be read or played back to the jury, including in situations where the witness decides to change his or her story at a later date.

Hospitalists are generally internal medicine physicians by training who have chosen to limit their medical practices to hospital-based medicine. They treat acutely ill hospitalized patients as attending physicians. They are responsible for playing the role of quarterbacks who manage the overall medical care, including consulting and working with specialists from other fields.

Unfortunately for patients, sometimes hospitalists have an unmanageable patient load and practice medicine more like accountants checking off boxes to be paid rather than medical doctors providing individualized care to their patients.

In my opinion, that is what the two defendant hospitalists were doing when it came to my clients’ care. It began with an emergency room visit for excruciating abdominal pain, nausea, and vomiting.

The emergency physician ordered an appropriate workup of tests, including an abdominal CT scan. The ER doctor also ordered laxatives that should relieve the constipation and medications to relieve the patient’s pain and discomfort and to stop the nausea and vomiting.

After admitting the patient to the hospital, the hospitalist physicians took over as attending physicians responsible for managing her care. Hospitalists typically work 12 hour shifts from 7:00 a.m. to 7:00 p.m. Hospitalists covering the night shift are called nocturnists, and they punch in when the dayshift punches out.

Sadly, the patient care provided by these hospitalists showed no critical, independent thinking and instead resembled an airplane on autopilot. The problem with their plan of care is that they stuck to the original plan even though it wasn’t working, and the patient didn’t get better after multiple days.

At the deposition, both physicians admitted that there were some telltale signs that placed this particular patient at an increased risk of a serious medical culprit hiding behind her problems. She had a prior history of cholecystectomy (gallbladder removal), a Roux-en-Y gastric bypass, and a prior internal mesenteric volvulus hernia that had been surgically repaired about six months earlier. All of these set her up to have an increased risk of a small bowel obstruction or volvulus (twisted intestines that can cut off blood flow in the depth of the bowel).

Despite actual knowledge and consideration of small bowel obstruction and volvulus in the differential diagnosis, both physicians continued blasting the patient with more and more laxatives. When someone has a small bowel obstruction and is on laxatives, the result can increase the pressure and can cause more discomfort and other complications. They also ordered continued narcotic pain medications, such as Dilaudid, which reduce the peristalsis movement of the bowel, which only complicated the constipation.

While the original treatment plan of pain killers, anti-nausea medication, laxatives, and enemas seems like a reasonable first step, each subsequent encounter with the patient, the hospitalists were responsible for re-assessing the patient and making course corrections in the plan of care. After multiple days of the constipation, abdominal pain, and nausea and vomiting persisting despite treatment, the hospitalist failed to consider other potential causes of this patient’s problems. Even though all signs pointed away from the simple answer, the hospitalists maintained their flawed course until it was too late for the patient.

What happened next in the treatment was absolutely bizarre, unless one considers the psychological concept called fundamental belief perseverance. This means that a person becomes so entrenched in the belief that even opposing evidence is discounted, not considered, and even further strengthens a belief that is not based on fact or evidence. I think that is what was at play with these hospitalists.

Four days into the hospitalization, one of the hospitalists orders and abdominal x-ray. The radiologist who interpreted the x-ray wrote a report that specifically stated it could not exclude the possibility of a small bowel obstruction. Yet, at deposition, the hospitalist said that the report was not concerning.

The next day, five days into the patient’s hospitalization, a repeat abdominal x-ray showed progression of the small bowel obstruction. Finally, a hospitalist ordered a stat (as soon as possible) abdominal CT scan shortly before clocking out at 7:00 p.m.

The hospitalist left no instructions to be notified of the results overnight and, thus, did not learn about the radiologist’s interpretation that the CT scan showed a collapsed colon and small bowel obstruction until the next morning. The hospitalist ordered a surgery consult, which ultimately resulted in the patient being taken back to surgery the next day.

By then, it was too late. A laparoscopic surgery had to be suddenly converted into a full open procedure. The patient’s bowel was so swollen and edematous that a significant portion of her intestines had to be removed. This left her with uncontrollable diarrhea for life, as well as scarring and pain.

The patient did her part by recognizing her emergency medical condition and going to the hospital to get help. The hospitalists dropped the ball day after day after day, leading to this entirely avoidable injury.

If you have been seriously injured because of poor hospital or hospitalist care in Texas, then contact a top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.