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Pulmonary Emboli Results in Patient Death
ISSUE: What is a treating physician's duty to monitor a patient after a consultation?
An obese patient underwent a neurosurgical procedure that prohibited ambulation and the use of post-operative anticoagulant therapy for several days; compression stockings were employed as a deep vein thrombosis (DVT) prophylaxis. Over the next fifteen days the patient exhibited indications of atalectasis, pneumonia and hypoxia. The neurosurgeon consulted with a pulmonologist who recommended several courses of antibiotics and respiratory therapy.
Neither physician considered or ruled out pulmonary emboli as a potential cause of the patient's clinical symptoms. As a result of pulmonary emboli, the patient experienced prolonged and severe distress before his death. An autopsy demonstrated multiple emboli of varied age.
The family sued both physicians. The neurosurgeon contended that he was not liable for diagnosing DVT and pulmonary emboli because he had consulted a pulmonologist to treat the patient. The neurosurgeon's testimony, however, described his extensive experience conducting various complicated surgeries. Expert medical testimony clearly indicated that DVT and pulmonary emboli are inherent complications of any surgical procedure.
An obese patient underwent a neurosurgical procedure that prohibited ambulation and the use of post-operative anticoagulant therapy for several days; compression stockings were employed as a deep vein thrombosis (DVT) prophylaxis. Over the next fifteen days the patient exhibited indications of atalectasis, pneumonia and hypoxia. The neurosurgeon consulted with a pulmonologist who recommended several courses of antibiotics and respiratory therapy.
Neither physician considered or ruled out pulmonary emboli as a potential cause of the patient's clinical symptoms. As a result of pulmonary emboli, the patient experienced prolonged and severe distress before his death. An autopsy demonstrated multiple emboli of varied age.
The family sued both physicians. The neurosurgeon contended that he was not liable for diagnosing DVT and pulmonary emboli because he had consulted a pulmonologist to treat the patient. The neurosurgeon's testimony, however, described his extensive experience conducting various complicated surgeries. Expert medical testimony clearly indicated that DVT and pulmonary emboli are inherent complications of any surgical procedure.
From your analysis of the case, assess whether the following statesments are true or false:
| * | After a consultation, a requesting physician must follow the specialist's recommendations without reservation. | True or False |
| * | A surgeon is expected to be competent in both the technical aspects of a surgical procedure and in the management of postoperative complications. | True or False |
| * | Only pulmonary specialists have the training and experience to detect and manage pulmonary emboli, therefore a surgeon may rely exclusively on a pulmonology consultation for the clinical management of a postoperative patient where a pulmonary embolism is in the differential diagnosis. | True or False |
Expand to check answers
GENERAL PRINCIPLE: When a condition is common to both the practice of a treating physician and that of a consulting specialist, the treating physician has a duty to clinically manage the patient's presenting illness.
APPLIED PRINCIPLE: A specialist is held to a standard of care that requires his best clinical judgment, knowledge, skill and experience. Thus, a specialist may be held to a higher standard of care than a generalist. Although not board certified in pulmonology, he was a board certified and experienced neurosurgeon with the requisite knowledge and experience to diagnose and treat DVT and pulmonary emboli. During recovery, the patient succumbed to an inherent complication of surgical procedures.
This non-ambulatory postoperative patient had multiple risk factors for pulmonary embolism. Although it was reasonable for the neurosurgeon to rely upon the pulmonologist's advice, he was also obligated to continue caring for the patient using his own experience and training in postoperative complications and could not defer exclusively to the consultant.
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APPLIED PRINCIPLE: A specialist is held to a standard of care that requires his best clinical judgment, knowledge, skill and experience. Thus, a specialist may be held to a higher standard of care than a generalist. Although not board certified in pulmonology, he was a board certified and experienced neurosurgeon with the requisite knowledge and experience to diagnose and treat DVT and pulmonary emboli. During recovery, the patient succumbed to an inherent complication of surgical procedures.
This non-ambulatory postoperative patient had multiple risk factors for pulmonary embolism. Although it was reasonable for the neurosurgeon to rely upon the pulmonologist's advice, he was also obligated to continue caring for the patient using his own experience and training in postoperative complications and could not defer exclusively to the consultant.
| * | After a consultation, a requesting physician must follow the specialist's recommendations without reservation. | False |
| * | A surgeon is expected to be competent in both the technical aspects of a surgical procedure and in the management of postoperative complications. | True |
| * | Only pulmonary specialists have the training and experience to detect and manage pulmonary emboli, therefore a surgeon may rely exclusively on a pulmonology consultation for the clinical management of a postoperative patient where a pulmonary embolism is in the differential diagnosis. | False |