Risk Management Monthly / Emergency Medicine – Case of the Month, February 2018

Seward v Metrolina Medical Associates (South Carolina) – A patient presented with shortness of breath and chest pressure after a lengthy airplane flight. He was accompanied by his wife. The chief complaint on the ED chart listed “cough and shortness of breath.” A chest x-ray was reported as negative for pneumonia, and the patient was discharged with a diagnosis of bronchitis. He died the following day. The autopsy listed pulmonary embolism as the cause of death. At the malpractice proceeding, the plaintiff’s attorney pointed out that the diagnosis was missed despite the presence of classic PE symptoms after a longplane flight. The defendant falsified the records after the fact (indicating that the patient had declined an ECG, reported productive cough, and had a negative calf exam for tenderness and swelling). The defendant claimed that this documentation was completed in the presence of the patient and his wife, but examination of the EHR showed that this documentation occurred after the diagnosis was known. The case was settled for $3 million.

The RMM panel notes that:

  • In the age of electronic medical records, it’s easy to determine the timing of documentation. Be aware that juries are likely to come down hard on you if you are dishonest in your testimony.
  • In Dr. Henry’s experience, he is unaware of a single case in which the defendant has prevailed after it is demonstrated that he/she has charted something that was not actually done or said something that was later found to be untrue.