We represent a client—we’ll call her Christy–who fell and face-planted on a sidewalk. She was so injured in the fall that she couldn’t turn herself over, despite the weather being freezing cold.
A neighbor called 911 and when emergency medical services (EMS) assessed Christy, they wrote in their record that she might have a spinal cord injury or head injury. That led to a trauma activation to a nearby hospital emergency room (ER).
Let’s briefly fast forward: Christy ended up being discharged from the ER and a few days later was found to have a spinal cord injury. Despite a delayed spine surgery, Christy largely can’t use the right side of her body, which is her dominant side.
ER mismanagement
I spent this afternoon taking the deposition of the ER physician who was the attending physician responsible for Christy’s care at a Houston hospital. Here’s what we learned from this doctor’s testimony and the hospital’s medical record:
• Although Christy complained of extreme pain in both hands, the ER doctor never documented an exam of her upper extremities or hands.
• Although Christy complained to EMS, ER nurses, and the ER physician that she couldn’t feel her lower extremities and had decreased motor function in her legs, the ER doctor never documented an exam of her legs.
• Christy was in the ER for about 8 hours, and her pain level increased from 6/10 to 8/10 by the time the ER doctor discharged her. From the time of her fall, she was medicated with ketamine, fentanyl, morphine, and Norco to manage her pain. The ER physician never addressed her increasing pain in his documentation.
• The ER doctor noted that Christy had completely recovered about 7 hours after she arrived at the ER, but didn’t document any exam findings. Within an hour of his discharge decision, the ER nurse noted that she told the ER doctor that Christy had weakness.
• Throughout the medical record, Christy’s subjective complaints, diagnostic radiology findings, and exam findings didn't mention any back problems. Yet, the ER physician discharged Christy and sent her home with the bizarre diagnosis of back sprain/strain.
• It took three people from the hospital staff to load Christy in a wheelchair to get her out of the ER. As they were doing so, the nurses noticed that the patient was still weak and informed the ER doctor. The ER doctor didn’t see the patient, stop the discharge, or do any further workup.
• It took another three people to load Christy into a family member’s truck.
Patient safety out the window
The ER doctor and nurses told Christy that she had back sprain/strain and frostnip. The discharge instructions told her to go see her primary care provider in 2–3 days and only to return to the ER if her condition got worse.
Over the next three days, her condition remained the same. She couldn’t move her arms and legs. A loved one finally called an ambulance again, which took her to a different hospital, where her spinal cord injury was appropriately diagnosed. By then the damage was done, though.
Here are some things you can do to improve your own safety as an ER patient:
• Before discharge, get a thorough explanation from the doctor about your diagnosis and what evidence supports it. When I asked the ER doctor today what supported his diagnosis that Christy had back sprain/strain, he gave me an embarrassed and blank look. He could point to nothing.
• If the diagnosis and instructions don’t make sense, speak up. Emphasize the complaints that brought you to the ER in the first place. If you can’t move your arms and legs when you enter the ER and can’t move them when they’re trying to discharge you, speak up. In a trauma situation, the inability to stand up and walk is a big deal, so make sure everyone knows about that.
If you’ve been seriously injured because of poor ER or trauma care in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.
