Legal Pearls: Defense Verdicts for Doctors

There are many misperceptions when it comes to medical malpractice cases, but one of the biggest is that the plaintiff generally wins. Despite news headlines about huge verdicts, the truth is that most claims never go to trial, and in those that do, the defense is more likely to win. According to data from the National Practitioner Data Bank, medical malpractice payments have consistently been dropping since 2001. This month, we look at a case where a physician went to trial but was exonerated by the jury.

Clinical Scenario

The physician worked in an emergency department. One January day, an 89-year-old woman was brought in from the nursing home where she was residing. The patient had been experiencing abdominal pain and vomiting. He was the first physician to treat the patient. After the examination, he ordered pain medication and a computed tomography (CT) scan.

He knew that a CT with contrast would provide the most information, but based on the patient’s kidney function, the physician did not believe the patient would be able to tolerate the contrast dye. He ordered the scan without contrast, and when the results came back normal, he discharged the patient from the emergency department.

The patient died 2 days later. Her cause of death was mesenteric ischemia—that is, inadequate blood flow resulting in a gangrenous bowel.

The Lawsuit

After her death, her bereaved family hired an attorney to file a lawsuit against the physician. The family claimed that he was negligent in his treatment of the patient, and his negligence resulted in her death. Although they alleged that the physician was careless in his evaluation of the patient and that he failed to immediately order a surgical consultation, the case came down to the CT scan and whether contrast should or should not have been ordered.

As the case inched closer to trial, the plaintiff’s family made a settlement demand for $900,000 to $1.5 million to resolve the case without a trial. The physician’s attorney, provided by his malpractice insurer, advised him against settling the case. “You had a valid reason to avoid the CT with contrast,” said the attorney. “You did not breach your duty to your patient.” He did not settle, and the case went to trial.

The Trial

The trial lasted for 5 days and involved the testimony of numerous physicians, as well as many family members. The family introduced medical testimony asserting that he should have been more aggressive in determining the cause of the patient’s condition, that his examination had been rushed, and that his determination to order a CT without contrast was wrong.

The physician’s attorney introduced expert testimony from an emergency department physician. The expert explained to the jury that the condition is often described as being a heart attack of the bowel, where a blood clot in the vessel feeding the bowel disrupts blood flow, causing tissue damage. “It’s very hard to diagnose, because it has nonspecific symptoms,” the expert added.

The physician testified that based on the patient’s kidney function levels, he felt contrast would be too dangerous. “Not everyone can tolerate contrast,” he told the jury, “and based on my experience, it was and is my belief that this patient was one of them.” He pointed out that he had noted his thinking on the chart at the time.

During his closing argument, his attorney noted that he had not breached his duty to his patient. “He was, in fact, making the safest choice for her at the time,” said the attorney, “based on the information he had. This is how emergency medicine works.”