I handled an emergency room medical malpractice case involving a passenger in a car that was in a high-speed motor vehicle accident (MVA). This patient’s car crashed into another parked car. Unfortunately, he wasn’t wearing a seatbelt and was ejected from the car through the front windshield.
As you can imagine, when the ambulance dropped him off at the nearest hospital emergency room (ER), the doctors and nurses had a lot of work to do. This young man had obvious injuries from head to toe.
Under the standard of care, any ER physician encounter with a new patient should include a patient history, physical exam, and formulation of the differential diagnosis.
In this case, the patient history was obvious and straightforward. Emergency medical technicians (EMTs) shared the facts of the MVA that had recently happened. Next came the physical exam, which was literally head to toe.
In my experience, the next step is where many doctors and patients run into trouble. Sometimes it’s because bias sets in. By bias, I don’t necessarily mean racial or gender prejudice. Instead, there is a tendency to allow an anchoring bias to mislead the doctor into making a diagnosis that’s potentially wrong.
The differential diagnosis process is something that’s taught to every future doctor in medical school. After obtaining the patient history and conducting a physical exam, the doctor is required to formulate a mental or written list of every potential diagnosis that could explain the patient’s conditions and clinical status.
Once the physician assembles the differential diagnosis list, the standard of care requires doing further evaluation, including ordering consultations with medical specialists, lab work, or diagnostic radiology studies, to rule in or rule out each item on the list. Importantly, the standard of care requires doctors to start this process with the most dangerous potential diagnosis on the list.
If you think about it, that just makes common sense.
Unfortunately, though, some doctors give in to the temptation of anchoring bias and skip those important steps. This type of behavior needlessly endangers patients, including people who were injured in car wrecks.
What happened in this young man’s care illustrates the importance of starting with the most dangerous potential diagnosis. In a front-end collision, the blunt trauma forces on the body could damage any major organ system.
The emergency room doctors and nurses were busy treating injuries that weren’t life-threatening and didn’t work up the possibility of a cardiovascular issue. Later, they learned that this patient’s aorta had a small tear in it from the car wreck. He wasn’t initially paralyzed, but with every passing beat, the tear grew larger. Ultimately, because it wasn’t timely diagnosed and treated, his aortic dissection caused permanent sensory and motor paralysis from the nipple level down.
We’ve recently been working on another Texas emergency room medical malpractice case involving a middle-aged man who was seriously injured after he ran his car into a tree. In that case, the emergency physician appropriately ordered multiple x-rays and CT scans of the patient’s whole body, except his neck.
That’s really hard to understand, given the fact that the ER providers were aware of the front-end MVA and that the airbag deployed because the force of the collision.
The ER physician also ordered a consultation with trauma surgeon, who also decided against ordering a CT scan of the neck.
It seems like the entire ER team fell victim to anchoring bias, focusing on the other obvious injuries, rather than forming and working through a proper differential diagnosis list.
Later on the date of the MVA, the trauma surgeon took the patient to the operating room for a lengthy procedure to repair abdominal injuries that were not life-threatening. By the time the patient woke up from anesthesia the next morning, he had no feeling or movement essentially from the shoulders down.
Finally, a doctor thought it would be a good idea to order a CT scan of the neck. They discovered what they thought was a hematoma (bleed) causing compression on the spinal cord. Any time there is something that’s compressing the spinal cord, it’s generally called a space-occupying lesion. Because there’s only so much space between the spinal cord and the bony vertebrae, the standard of care requires prompt surgery to evacuate/drain the hematoma and decompress the spinal cord before there is a permanent loss of function.
Sadly, this man is left in a state of permanent quadriplegia because the doctors involved in his care in the emergency room didn’t follow the differential diagnosis process. On top of that, various nurses working in the emergency room ignored their fundamental nursing duty to advocate for proper care of the patient, which would include orders for a CT scan of the neck to rule out any type of pathology problem that could cause compression or damage to the spinal cord.
If you’ve been seriously injured because of poor emergency room care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
