Mr. M was treated at a local clinic for abdominal pain. She was accompanied by her husband. Mr. M was examined by Mr. P, a PA. Mr. P examined the patient and recorded symptoms including bloating, nausea, lower abdominal and back pain, diarrhea, vomiting, constipation, and recurrent fever. Ms. P ordered an X-ray of her abdomen, which revealed that her abdomen was distended. Mr. P did not order any additional diagnostic tests.
Mr. P consulted Dr. S, the attending physician at the clinic. Both doctors believed that Mr. M was suffering from a temporary gastrointestinal problem that was likely to resolve on its own. Mr. P instructed the patient that he should continue on a clear liquid diet for 1 to 2 days until he felt better and sent him home.
However, the next day, Mr. M returned complaining that the pain did not go away. At this time, she was seen by her NP, Mr. R, who has the same attending physician as her PA. The NP also diagnosed Mr. M with a mild gastrointestinal disorder and instructed him to continue on a bland liquid diet.
Continue reading
Two days later, Mr. M returned to the clinic to see his primary care physician. However, they arrived late and the appointment was cancelled. At this point, Mr. M decided to take his wife, who was in severe distress, to the emergency department of the local hospital. Emergency room physicians noted that Mr. M was in severe pain, disoriented, had a fever, and was in physical pain. The ER physician ordered diagnostic tests that showed abnormal values and ordered an ultrasound and computed tomography (CT) scan of Mr. M’s abdomen. Scans revealed that the patient was suffering from a significant inflammatory reaction, likely due to appendicitis.
Mr. M was taken by Rife to another hospital, where surgeons performed an appendectomy. After she recovered, Mr. and Mrs. M. consulted with the plaintiff’s attorney and filed a medical malpractice suit against the clinic and the practitioner. They claimed that Mr. M suffered injuries as a result of the clinic’s failure to accurately diagnose appendicitis and provide timely treatment.
Months after the discovery, both sides filed motions for summary judgment, asking a judge to immediately rule the case in their favor. After a hearing, the court dismissed the plaintiffs’ lawsuit against the clinic for failing to disclose an expert witness testifying about the doctor’s standard of care. Mr. M appealed this decision and the case went to the Court of Appeal.
appeal
The court first noted that the complaint needed to be examined to determine whether the complaint contained a claim. The court stated, “To succeed in a medical malpractice claim, a plaintiff must prove a negligent act or omission that fell below the standard of care and caused the injury.” To that end, if the issue involves “special knowledge, skill, or experience in a subject matter that is not within the ordinary experience of the jury and requires special study, study, or experience,” , the court said expert testimony was required. “Without expert testimony, the jury would lack a standard for determining whether the defendant failed to exercise the degree of care and skill of a reasonably prudent physician.”
The plaintiffs argued that expert testimony was unnecessary because the standard of care governing medical malpractice claims is “within the knowledge and understanding of the average layman.” The court disagreed, stating that “diagnosis of appendicitis is a matter that is not within the knowledge or experience of a layperson, and the symptoms of appendicitis are not a matter of common sense or experience that would enable a layperson to recognize the disease.” . Presentation…Concludes that the diagnosis of appendicitis requires specialized knowledge and that testimony regarding the standard of care applicable to that diagnosis must be from well-informed and trained expert witnesses . ”
The plaintiffs then insisted on calling a surgeon who was already on the witness list to testify about the standard of care. The court refused to accept this, noting that expert witnesses must have sufficient knowledge of the subject on which they testify and that surgeons are not qualified to testify about PA, NP, or emergency standard of care. did. Doctor in the room. The standard of care applied must be by a professional with training and knowledge similar to the defendant’s practitioner.
Finally, the plaintiffs called PAs, NPs, and emergency room physicians (all of whom are on the witness list) to testify as experts regarding the appropriate standard of care for PAs, NPs, and emergency room physicians. insisted. Clearly, the defendants did not want that to happen, and the court noted that the plaintiffs “cannot compel any of the named defendants to comment on the standard of care.” . The court continued: Absent very special circumstances, “a medical witness who is reluctant to testify as an expert — and the witnesses here are clearly unwilling to do so — would be unable to comply with the applicable standard.” There is no need to express an opinion on treatment.” If the plaintiffs had called the clinicians to testify, their testimony would be limited to describing their own treatment of Mrs. M.
Based on these reasons, the appellate court agreed that the lower court properly dismissed the case.
protect yourself
Neither the PA nor the NP were found liable in this case, which may have been due in large part to a technical flaw in the plaintiffs’ presentation of expert testimony in support of their case. The results might have been different if expert testimony had been included, especially for NPs who treated patients who were still in physical pain after returning to the clinic. Should the NP have ordered more tests, more imaging tests at that point? Without the opinion of medical professionals, no one can know. However, if the patient relapses with the same symptoms, it is a reminder that it is wise to take a closer look at possible causes.
Ann W. Ratner, Bar Doctoris a former criminal defense attorney and freelance medical writer in Port Washington, New York.