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Home » My Practice » Legal Advisor

Publish Date February 17, 2022


PATIENT SUES NP FOR MISSED DIAGNOSIS OF HIP FRACTURE… BUT IS THAT MALPRACTICE?

Ann W. Latner, JD

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A medical malpractice case requires a duty owed to the patient, breach of that
duty, injury caused by the breach, and damages. Credit: © Willie B. Thomas/Getty
Images


In early January, a 76-year-old patient, Mrs R, was brought by her husband to
the emergency department (ED) of a local hospital after sustaining a fall
outside her home. Working in the ED that night was Ms W, a family nurse
practitioner, and Dr T, the ED physician.

Ms W went into the examination area to speak with Mrs R, who complained of left
groin pain that radiated to her lower back. When Ms W asked if anything
triggered the pain, Mrs R said that several packages were left outside her door
and when she leaned over to pick them up, she fell and has experienced pain
since.

Ms W took a medical history and then performed a physical examination of the
patient. She noted that Mrs R’s lower back was tender toward the sacral area and
that the patient was unable to perform a straight leg raise because of pain. The
differential diagnosis included hip fracture, and Ms W ordered radiographs of
the patient’s pelvis, including the femoral neck and knee.

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After the radiograph results were back, Ms W conferred with Dr T, the ED
physician. Dr T interpreted the images as showing no indication of a fracture
and Ms W concurred. Meanwhile, the patient had been given pain medication and
was doing better.

Mrs R was told that she would be discharged with pain medication and Ms W
instructed her to follow up with her primary care provider. Ms W noted in the
medical record that the patient’s condition had improved and that she advised
the patient to contact her doctor for follow-up.

Two hours after she left the first hospital, the patient had her husband take
her to another hospital where she complained about the same pain that she had
sought treatment for at the first hospital.

At the second hospital, a computed tomography (CT) scan of Mrs R’s pelvis was
conducted. The CT scan revealed a hip fracture. An orthopedist who was consulted
recommended that Mrs R be admitted to the hospital for pain medication and
physical therapy but advised that nothing should be done surgically.

A few days later, Mrs R was admitted to a physical rehabilitation institute for
continued physical therapy and treatment, which consisted of stretching ,
strengthening, and range of motion exercises as well as bone stimulation.
According to the rehabilitation facility, she made progressive improvements and
was discharged 2 weeks later.

Some months later, Mrs R filed a medical review board complaint alleging medical
malpractice by Ms W and Dr T for her treatment at the first hospital. The
medical review panel found the defendants did not breach the standard of care or
cause the damages Mrs R alleged and dismissed the complaint.

Mrs R then filed a lawsuit against Ms W and Dr T in state court.

LEGAL BACKGROUND

The defendant clinicians made a motion for summary judgment asking that the case
be dismissed. A hearing was held and the trial court dismissed the case. Mrs R
appealed. On appeal, the appellate court was asked to decide whether dismissing
the case was a proper action by the lower court.

The court noted Mrs R would have the burden to prove 3 things at trial:

 * The standard of care
 * That the defendants breached that standard of care
 * That a causal connection existed between the defendants’ breach and the
   patient’s alleged injuries

The court pointed out that the only thing Mrs R presented at the hearing on the
summary judgment motion was the affidavit of a Dr O. In his affidavit, Dr O
stated that the standard of care for an older patient who presents with
continued pain in the pelvic and hip areas despite negative radiographs is to
order a CT scan or magnetic resonance imaging (MRI) of the pelvis to detect
fractures that radiographs may miss.

He also said that, in his opinion, Ms W and Dr T had breached that standard of
care by not ordering a CT or MRI of Mrs R’s pelvis. This is evidence that
supports Mrs R’s burden of proof for 2 of the 3 elements in the medical
malpractice claim, said the judge in the decision.

Still, Dr O’s affidavit made no mention of what, if any, injuries Mrs R had
experienced. At the trial, the court found nothing in the affidavit to show that
the breach of standard of care was linked in any way to the patient’s injuries.

In fact, Mrs R never alleged that she experienced any injuries at all from the
2-hour delay in her diagnosis. This was a flaw in her argument: if there are no
injuries, there is no medical malpractice case. Even if the treatment by the
practitioners had fallen below the standard of care, if it did not result in
injuries that could be causally tied to the breach, then there is no valid
medical malpractice case.

PROTECTING YOURSELF

It is extremely important to be familiar with the 4 required elements of a
medical malpractice case:

 * A duty owed to the patient
 * Breach of that duty (of the accepted standard of care)
 * Injury caused by the breach
 * Damages

Without each of these elements, a medical malpractice case will fail. Litigious
patients sometimes mistakenly believe that just because a clinician made an
error there is ground for a malpractice case. Without the other required
elements, simply making an error (such as failing to order a CT or MRI for the
patient) does not rise to the level of medical malpractice.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical
writer in Port Washington, New York.


TOPICS:

Legal Advisor Orthopedics


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