Case 8: Tumor Board
The patient’s case was presented at the tumor board. The report from the tumor board is shown below. It is bonus content exclusively for email subscribers. The patient was not felt to be a surgical candidate. He was referred for chemotherapy and radiation therapy. Chemotherapy was initiated but notes were not included in the medical […]
Case 8: Specialty Consult
The patient was seen by a pulmonologist before the CT was completed. Their consult note is shown here. The pulmonology team reviewed the patient’s imaging history. They reviewed the chest xray from the urgent care visit 3 years prior, and also found this CT chest that was taken about 5 years prior. The CT scan […]
Case 8: Follow-up
The patient does not have any documented visits for the following 3 years. At that point, he went in for an appointment to establish care with a primary care physician. The x-ray was obtained the same day as the office visit. The interpretation of the x-ray is quite concerning. It is shown below for subscribers. […]
Case 8: Cough
This month’s case is about a 63 year old man who went to an urgent care with a cough. The triage note and nursing documentation through discharge are shown below. Note the vitals showing a temperature of 98.4 F, heart rate of 123 bpm, respiratory rate of 15/min, blood pressure of 129/94, and oxygen saturation […]
Case 7: Documentation Review
This month we will be reviewing the documentation from the initial ED visit. It is shown below for reference. In order to assess the note, we will be using the Documentation Rubric. If you are looking for a structured way to write fast, defensible notes on your next shift, use the Documentation Template. The Rubric […]
Case 7: Case Review
The diagnosis of necrotizing fasciitis (NF) can be very challenging. It is one of the disease processes that can have very subtle findings initially, but can rapidly progress to critical illness. Benign initial appearanceOften times, the initial history and exam appear consistent with cellulitis. Obvious cases of NF are easy to identify, but the vast […]
Case 7: Legal Outcome
The judge’s ruling is shown below. The court’s opinion addresses the false conception that a misdiagnosis constitutes an EMTALA violation: The judge addressed the claim that under EMTALA, a hospital must provide screening that is outside of its capabilities. The plaintiff also claimed that delays in the patient’s care constituted an EMTALA violation. While there […]
Case 7: Defense Response
The hospital’s law firm responded vigorously to the plaintiff’s claims. They first address the EMTALA requirement for medical screening. In particular, they note that the screening must be done in a way consistent with other patients presenting with similar complaints. Faulty screening that fails to identify an underlying emergency does not constitute an EMTALA violation […]
Case 7: Plaintiff Claims
The plaintiff’s attorney filed a lawsuit alleging violation of EMTALA. The complaint spans 34 pages and 84 paragraphs. Rather than including the entire document, relevant selections are shown below to illustrate the claims. EMTALA claims are not brought against specific individuals, they are brought against the hospital. EMTALA requires that patients presenting to an ED […]
Case 7: Outcome
The patient was admitted to the hospitalist. Broad spectrum antibiotics were started. The progress notes written by the patient’s doctors are shown below. The following day, the patient was taken to the operating room. Continue to the next page to see the lawsuit that was filed and the plaintiff’s claims.