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Doctor Commits Medical Malpractice: Medical Care Required to be Informed by Hospital Policies

Victor Lewin - Friday, October 11, 2013

A new medical malpractice decision from the Court of Appeal was released earlier this summer. It affirms a finding of medical negligence on the part of a doctor. This case is important in that it highlights that issues concerning the responsibilities of the various doctors involved in a patient's care must be considered in light of a Hospital's policies.

A young lady was 36 weeks pregnant when she went into the Hospital with a severe, sudden onset of chest pain and shortness of breath.

Her doctors suspected either a pulmonary embolism, a blood clot in the lung, or an aortic dissection, a tear in the wall of the aorta. Both are serious, life-threatening conditions. The doctors ordered various tests and admitted her to the Hospital.

After approximately a one week stay in Hospital, the patient was scheduled to be discharged. Sadly, shortly before her discharge, she collapsed on the floor and died from a ruptured ascending aortic aneurism. Fortunately, her daughter was successfully delivered by an emergency caesarean section.

The young mother's husband hired personal injury lawyers to commence a medical malpractice lawsuit against the doctors, nurses and the Hospital. In particular, the action focused on her obstetrician, the doctor designated to be her "Most Responsible Physician".

At trial, the trial judge found that the obstetrician acted negligently for failing to treat the woman's heart-related problems as an emergency requiring an immediate cardiac consultation and transfer to a tertiary care centre. This finding came in spite of the obstetrician's argument that he was entitled to rely on the reasonable advice of a qualified consulting respirologist.

The doctor appealed the trial decision.

The Court of Appeal found also found that the doctor had committed medical malpractice and that he was responsible for the plaintiffs' injuries. The decision largely focused on the Hospital Policy:

IT IS THE POLICY OF THE HOSPITAL THAT:

"The Most Responsible Practitioner/Attending Practitioner" (MRP) is the practitioner most responsible for the hospital care of a particular patient. The MRP is responsible for writing and clarifying orders, and providing a plan of care, obtaining consultations as appropriate, coordinating care, as well as the discharge process. Staff concerns about a patient should be directed to the MRP.

The MRP is to maintain communication with the patient's relatives and maintain/liaison if necessary, with consultants and family practitioners involved in the patient's care.

The MRP will be the admitting practitioner or such other practitioner to whom the patient has been transferred, from time to time, in accordance with the Rules. There shall be only one practitioner at any one time referred to as the most responsible practitioner.

The Court judge found that the obstetrician did not exercise critical judgment or provide an appropriate plan of care for his pregnant patient and, accordingly, failed to fulfill his responsibilities as the MRP. This was found to amount to medical malpractice.

The Court further agreed that the medical negligence resulted in the unfortunate death of the young patient. It held that had the doctor not abdicated his responsibility to his patient, the cardiac evaluation of her and her transfer to a tertiary care centre where additional expertise and facilities were available, the necessary surgery could have been completed days before her untimely death (thus, it could have been prevented).

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