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Tort Reform - Radiologist tired of waiting, hangs up phone - treating physician doesn't get message - patient dies

By Steve Lombardi

There have been several posts about how after tort reform some products and services take on the appearance of being at the level and quality of what you can expect while visiting an undeveloped country. But Ben Glass' story about the case of Tameika Williams vs. Cong Le, MD as reviewed by the Virginia Supreme Court demonstrates how patients lose control over the quality of their health care when tort reforms remove the threat of being held accountable.

Tawanda Williams is seen by her physician for pain in the right calf and leg. She returns one week later complaining of ankle pain and discomfort in her calf. The doctor orders an ankle x-ray and a Doppler ultrasound of her calf to be performed within 48 hours. The next day thepatient is seen at the Tyson Corner Diagnostic Imaging for the ultrasound. A diagnostic radiologist over-reads the results and suspects the images show a deep vein thrombosis in the right lower leg. "The presence of a deep vein thrombosis put Williams at risk for pulmonary embolism, a life-threatening condition in which pieces of a deep vein clot break off and slip out of the vasculature of the legs and travel into the lungs."

Next read the Virginia Supreme Court's description of the facts and then you be the judge about whether tort reform is working for or against you - the patient. Is quality affordable care becoming more available or in some ways becoming degraded andless predictible?

Dr. Le telephoned Dr. McClain's office to tell Dr. McClain the diagnosis of Williams' condition. Dr. Le reached an automatic telephone system, followed the instructions, and then reached an operator. He told the operator who he was, that he was a radiologist, and asked to speak to Dr. McClain. The operator told Dr. Le she would have to locate Dr. McClain, and then she put Dr. Le "on hold." Dr. Le was "on hold" long enough that he "lost [his] confidence to get in touch with [Dr. McClain] at that moment." He stated that he was unable to leave a voicemail or talk to a human being. Dr. Le testified that previously he had problems communicating with the doctors at Kaiser by telephone. Dr. Le prepared a "wet read" (an emergency read) with his findings and drew a picture of Williams' lower extremity showing the location of the blood clots. He placed the wet read in a "wet read box" to be sent immediately by facsimile to Dr. McClain.

After the Doppler ultrasound was performed, Williams telephoned Dr. McClain on June 2. She left a message for Dr. McClain advising him that she had been told by Murphy to call him. Dr. McClain did not personally receive Williams' message.

At 10:43 p.m. on June 2, 2005, Dr. McClain sent the following electronic mail message regarding Williams to his clinical assistant, Lynne Stidman ("Stidman"): "Lynne - Would you get the results of the Doppler study of the leg from Tyson Corner Diagnostic Imaging Center. . . . Please place the result in a Pace note and message me. Thanks. Dr. McClain." "PACE" is Kaiser's electronic system for patient medical records and internal non-urgent messages. On the morning of June 3, 2005, Stidman called the imaging center and had the results of the Doppler study sent to her by facsimile. Stidman received the report and entered it into the PACE system. At 10:24 a.m. on June 3, 2005, Stidman sent the following message to Dr. McClain: "Patient's Doppler results are in the computer." Dr. McClain did not read Stidman's message until June 15, 2005, after Williams died.

Dr. McClain had an appointment scheduled with Williams on June 6, which Williams did not attend. Williams died on June 8, 2005, from a pulmonary embolism. Dr. McClain did not look at the results of the Doppler ultrasound of Williams' leg until February of 2006. Dr. McClain testified that normally, if there was a positive finding from a Doppler ultrasound, he would be notified by the radiologist with "direct contact," which was "[g]enerally voice-to-voice contact." Dr. McClain testified that had he received direct contact, he would have immediately started Williams on anticoagulant therapy. The plaintiff's expert testified that "anticoagulation would have prevented [Williams] from developing a pulmonary embolism," and that if the anticoagulant therapy had been started anytime before the morning of June 7, 2005, the treatment would likely have prevented Williams' death.

Is this the kind of health care American's desire? I think not.

If you'd like to read more about how measures sold as reforms place you at greater risk for injury read the following posts on the InjuryBoard.

Prescription drugs - Steve Lombardi

High cost of cheap batteries - Megan Roth

Las Vegas doctor facing criminal charges over Medicaid billing - Jane Akres.

Scott Kappes on hepatitis scare prompts state wide inspection in Las Vegas clinic that exposed potentially 40,000 patients to a risk of hepatitis.

Be aware, be vigilant and beware of anything being touted as a reform.©

Originally posted at InjuryBoard by Steve Lombardi

Full post as published by Des Moines Personal Injury Lawyer on June 15, 2008 (boomark / email).