Re: Not so hypothetical question
From: art fougner, md (evsono@pipeline.com)
Thu Mar 8 06:32:29 2001
Mark,
in New York, the daughter of a prominent politically connected
journalist died in a university hospital, having been admitted and
evaluated by housestaff, in contact with attending by phone only. young
woman ultimately died and in the ensuing brouhaha, NY mandated 24 hr
in-house attending coverage for housestaff as well as limiting on- call
shift time.
art
At Wed, 07 Mar 2001, Mark Perloe wrote:
>
>I was just asked to review a regarding a complication on a case involving a
>resident. A patient underwent a laparoscopy for pelvic pain. 48 hours later
>the patient reported to the ER complaining of increased abdominal pain,
>nausea and bloating. She was ultimately admitted and treated with hydration
>and anti-nausea medications. The ER note was written by the transitional
>resident. She was reportedly seen by a second year resident who concurred
>with the plan of management. Thirty six hours later a first year resident
>saw her and continued the same management plan despite persistent nausea &
>vomiting. The patient was in the hospital for at least 36 hours before
>documentation by an OBGYN resident on the chart. The attending note was
>written after 72 hours and suggested a general surgery evaluation. When
>queried regarding review of the residency manual and requirements for staff
>notification, most residents stated they never read the manual!
>The outcome of the case was disastrous. Multiple laparotomies and bowel
>resection, PE, and ARDS complicated the picture. The hospitalization was
>over three months.
>
>Unfortunately, there is not documentation that she was seen by other than a
>transitional resident for the first 36 hours. This case appears to be an
>example of the blind leading the blind with no responsible supervision. In
>fact, the residency program educational committee was not made aware of the
>situation until at least one year later! Luckily all but one of the people
>involved are no longer with the program, but I am concerned that a
>significant fault still lies with both the program and the resident for
>this adverse outcome.
>
>My questions are as follows:
> 1. What steps should be taken to avoid similar misadventures on a
>residency service?
> 2. What would be the appropriate level of penury for a resident
>showing such poor clinical judgement and failing to recognize a potentially
>life threatening surgical complication?
> 3. What about protocols for who can see ER patients? And should a
>consultation with a 4th year resident be required prior to discharging an
>ER patient?
>
>--
>Mark Perloe, M.D. http://grs.ivf.com 404-843-2229
>5445 Meridian Mark Rd, Suite 270, Atlanta, GA 30342
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
