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Publication: Physicians Responsible for Accurate Diagnoses

Publication

Physicians Responsible for Accurate Diagnoses

The heirs of a 23 year old man who died unexpectedly sued the young man’s physician in a case that clarified the law of contributory negligence in Pennsylvania.

The young man saw his physician for treatment and reported that he was vomiting and suffering from blurred vision, dry mouth, lightheadedness, and inability to work. The physician diagnosed him with influenza and allowed him to go home. She knew that the young man had a family history of diabetes and had lost 22 pounds since his previous visit, weighing only 144 pounds at 6’1″ tall. She suggested that he obtain a fasting blood draw within the next month. Less than one month later, the young man returned, complaining of nausea and vomiting. The physician found no fever, but noted that the young man’s heart rate was elevated. She diagnosed gastroenteritis and again sent him home, where he died the following day of diabetic ketoacidosis from Type 1 diabetes.

In the first trial, the judge instructed the jurors that they should consider the young man’s contributory negligence because he had not followed up on the physician’s suggestion that he have blood work.

Despite warnings from the local judge, the man persisted in his quest. In fact, he served a maximum sentence for violating the protective order, simply because he would not agree, in parole proceedings, to leave the woman alone. Shortly after his release from jail, the man sent a foreboding e-mail to the woman’s sister, suggesting that if the sister had anything she “ever wished to say” to the man or woman, she should do it right away.

But on appeal, the Pennsylvania Superior Court found that there was no basis for the jury to consider contributory negligence at all. The young man had reported all of his symptoms accurately and, on both visits, the physician had mistakenly given him an incorrect diagnosis. Patients are contributorily negligent when they do not report their symptoms accurately and completely. When a patient seeking a diagnosis accurately reports his or her symptoms, asks necessary questions, and listens to the physician’s answers, his or her duty as a patient is satisfied. Patients are entitled to rely on their health care providers’ diagnoses and directions.

The court found that the young man had not been negligent in failing to obtain a fasting blood draw prior to his death because the physician did not order testing or communicate any urgency but, instead, told the young man to follow up with blood work within the month. On the date of the young man’s death, just three weeks later, that month had not yet elapsed.

The court also noted that the physician’s second mistaken diagnosis of gastroenteritis superseded the young man’s delay in scheduling an earlier follow up consultation or obtaining a fasting blood draw. Having enlisted the doctor’s assistance on a second occasion and having apprised her again of his symptoms, the young man was entitled to accept her diagnosis of gastroenteritis and go home.

The prosecutors appealed and won. The appeals court held that when computer equipment is used to “threaten and terrorize” another person, it falls within the definition of “contraband” and must be forfeited to the state.

Patients’ responsibilities are broad and should be based on common sense. Patients promptly must report all symptoms and personal history, truthfully and completely. Patients are responsible for asking questions to be sure that they understand their physicians’ instructions. Patients are responsible for following those instructions. Finally, patients are responsible for requesting follow up consultations if their symptoms change or worsen. However, patients are not responsible for second guessing their health care providers or for detecting inaccurate diagnoses or poor medical advice. In malpractice claims, judges can instruct jurors to consider contributory negligence only when there is evidence that the patient has failed in a patient responsibility.