Welcome to medmalreviewer.com! The purpose of this site is to improve doctor’s medical knowledge and documentation by reviewing real-life malpractice cases. These cases are presented in long form, deep dive fashion, published monthly. Each case is broken down into several posts. To see more info about the website, here are links to the About Page and FAQs. Another helpful overview post is the 3 Goals of Documentation. I’ve created a Documentation Template to help doctors write notes that are easy to defend, and a Documentation Rubric to grade notes from malpractice cases.

Case 5 Index



Introduction

ED Bounceback

Outcome

Nurse Depositions

Nurse Expert Witnesses

Physician Depositions

Physician Expert Witnesses

Legal Outcome

Documentation Review

Medical Review



This case is about a 70 year old veteran who presented to a VA Emergency Department with pain in his left leg after falling on a deck about one week prior to presentation. Below is the triage documentation completed by one of the nurses.

The physician then saw the patient, documenting essentially the same history. The patient’s problem list is included.

The patient’s medication list:

The doctor decided to order several tests:

1) Labs: CBC, CMP, coagulation panel

2) EKG

3) US for left leg DVT

4) Chest xray

5) Left tib/fib xray

The labs and EKG could be obtained on-site, but the facility did not have the capability to do an ultrasound. They had an agreement with a nearby hospital, that any patient who needed an ultrasound would be transferred by ambulance, have the ultrasound, and then be transported back to the original facility.

Results of the tests are shown below. Readers may notice that some of the electrolyte results are not included, due to an oversight by the court system. They are not relevant to to the ultimate result in this case.



The patient had a subtherapeutic INR and was undergoing testing to rule out a DVT. Therefore, the doctor ordered a dose of warfarin as well as enoxaparin to ensure that he was anticoagulated. This was given before the patient left the ED to undergo the DVT ultrasound. A dose of furosemide was also ordered, presumably due to swelling of the patient’s leg.

Chest xray results:

Knee xray results:

At this point, it was the end of the doctor’s shift. The patient was still at the other hospital getting the ultrasound completed. The doctor documents a plan to complete the ultrasound (in process) and admit the patient once they return to the ED.

She signed out the case to the incoming doctor. The doctor who took over the patient’s care reviewed the results of the ultrasound after it was completed, which was negative for DVT. He re-examined the patient, and then discharged the patient. A consult for outpatient follow-up with orthopedics was placed. The documentation is below.

Nursing documentation from the ED visit is shown below.

What do you think the bad outcome will be in this case? Click through to the next page to find out!

Looking for other resources? Check out the review of Bouncebacks!