The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in a medical malpractice case present such issues to the court.
(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)
Dr. Black states in his declaration that plaintiffs injuries represented complex, if not major, trauma. Black goes on to state at 3:26-4:4 that complex or major trauma requires immediate involvement of an emergency department physician, for documentation, diagnosis, initial treatment and stabilization, and referral. Only minor trauma may be initially evaluated by a nurse practitioner … Dr. Black in his declaration has the benefit of 20/20 hindsight in that the true extent of plaintiff’s injury is now known. Upon plaintiffs initial presentation to XYZ Hospital, it may have been impossible to instantaneously recognize her injury as complex and/or major trauma. Here, plaintiff was ambulatory and brought herself voluntarily to the hospital, the day after falling at her home, with a complaint of neck pain.
The real crux of Black’s declaration begins at 4:5 wherein he chastises the inappropriate triage decision of placing plaintiff in urgent care, accompanied by the incomplete and inaccurate evaluation performed by nurse practitioner Paul Brown. This information is totally irrelevant to the potential liability of Dr. White. A decision by the triage nurse to send a patient to either a nurse practitioner or a physician is utterly out of Dr. White’s hands. Despite this lack of responsibility on Dr. White’s part, Black attempts to overcome this by citing to XYZ Medical Center’s Nurse Practitioner Standardized Procedures.
Dr. Black makes the blanket statement at 4:22 that Dr. White directly supervises the nurse practitioners and vaguely cites to page 19 of the Procedures. In actuality, Dr. Black is cherry picking pieces of the Procedures in an attempt to pin liability on Dr. White. The guidelines cited by Black are actually guidelines that govern the scope of a nurse practitioner’s duties.
Dr. Black at 5:6-10 inexplicably, and without any supporting citations to any evidence whatsoever, claims that Dr. White is formally designated as the attending physician, for not only financial purposes, but with the contractual expectation by the patient and the payor, that the clinical services rendered are at the level of a board-certified physician, even if initially provided by mid-level assistants, such as nurse practitioners. There is no evidentiary support for this statement! Dr. Black is not rendering an expert medical opinion on the standard of care but rather, interpreting a contract. According to his logic, every patient would need to be evaluated by the emergency physician on duty. This makes no sense. The hospital has a system whereby patients of lesser acuity, in the judgment of the triage nurse, are to be treated by mid level practitioners which include nurse practitioners and physician’s assistants, and those patients of greater acuity are to be treated by medical doctors. How can Dr. White provide care or direct care for a patient he did not know was in the emergency department, and he was not asked to see? (See Part 4 of 5.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.