Did a doc even see this guy?
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A Massachusetts hospital must pay $20 million to a man who lost his left leg after a blood clot was misdiagnosed as sciatica, according to a story posted on boston.com, the news site of The Boston Globe.
On March 7, 2015, Steven Luppold, at the time a construction worker, went to the emergency department (ED) at Lowell General Hospital, in Lowell, Massachusetts. He had a long history of sciatica. The pain often radiated down his left leg. This time, though, his discomfort in his left foot felt different.
At the ED, Luppold was initially examined by two nurses, who wrote in the patient's chart that his foot was turning purple and felt cool to the touch. He was next examined by a physician assistant (PA), Charles Loucraft, who made a diagnosis of worsening sciatica and sent the patient home. Court records suggest Loucraft made this diagnosis without having read the patient's chart.
Six days later, Luppold returned to the ED with severe pain — a 9 on a scale of 10, as he reported at the time. Again, he was seen by two nurses, one of whom had examined him the previous week. He was then examined by Carlos Flores, a nurse practitioner (NP), who reiterated the PA's initial diagnosis of sciatica. Once more, Luppold was sent home.
Four days later, on March 17, Luppold placed a call to his primary care physician (PCP), who worked at Lahey Hospital and Medical Center, in Burlington, Massachusetts, about 18 miles south of Lowell.
The PCP administered an ultrasound and diagnosed the patient as having a deep-vein thrombosis and an arterial thrombosis in his left leg. Luppold was taken immediately to the Lahey Hospital ED. A vascular surgeon ordered a CT scan, which indicated that the tissue in the patient's left leg was necrotic. The following day, with few options open to them, surgeons amputated the patient's left leg above the knee.
At some point after the surgery, Luppold filed a medical malpractice suit that named the PA, NP, and their physician-group employer, Merrimack Valley Emergency Associates, in Lowell. Also named in the suit were the three ED nurses who had examined him.
"Honestly, the reason this happened was because the communication...in the emergency department between the nurses and providers was nonexistent," says Robert M. Higgins, a partner at Lubin & Meyer, in Boston, who represented the plaintiff. Had providers ordered "a simple ultrasound" during either of Luppold's visits to the ED, Higgins added, his leg could have been saved.
The jury agreed. It awarded Luppold $10 million for pain and suffering and another $10 million in compensatory damages. -
2 nurses
PA
No help2 more nurses
NP
No helpMD
Identifies the problem - too lateThe second string missed it
I blame obamacare, millions more with health insurance, but without millions of new doctors
Are nurses, PAs or NPs accepted into training based on demonstrated skill or race and orientation?
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Here's the other thing I found interesting.
PAs and NPs usually do not work without supervision of some kind. The stories say that Lupold sued the hospital as well as the employer of the PA and NP. I would assume that some doc signed off on their diagnosis, and somehow, s/he was not sued?
If I were working with a CRNA, and things go south, leading to a lawsuit, you can bet that my name would be on the complaint. In fact, probably at the top.
About 10 years before I retired, I looked at a job north of the Cheddar Curtain. I was told that, although call was frequent, it was rare to have to come in. For simple cases and epidurals for labor, the CRNA would do the case, and I could sign the chart the next day. I ran away from that place.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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It was a shame he didn’t see a doc but frankly both PAs should have caught this.
Ironically my only visit to a rapid clinic (as opposed to an ER) I saw a PA for a large hematoma on my leg. He sent me for an ultrasound to check for a clot, which I didn’t have.
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It was a shame he didn’t see a doc but frankly both PAs should have caught this.
Ironically my only visit to a rapid clinic (as opposed to an ER) I saw a PA for a large hematoma on my leg. He sent me for an ultrasound to check for a clot, which I didn’t have.
@jon-nyc said in Did a doc even see this guy?:
It was a shame he didn’t see a doc but frankly both PAs should have caught this.
Absolutely. Talk about bad medicine.
Ironically my only visit to a rapid clinic (as opposed to an ER) I saw a PA for a large hematoma on my leg.
My most recent visit (about 13 months ago) was for my parotid gland swelling where I saw a NP. She diagnosed it as "cellulitis," which it wasn't. She prescribed an appropriate antibiotic. I saw my ENT friend the next day who diagnosed the parotitis and the salivary gland mass with a CT scan in his office. The NP gave the right antibiotic for the wrong diagnosis.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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@jon-nyc said in Did a doc even see this guy?:
It was a shame he didn’t see a doc but frankly both PAs should have caught this.
Absolutely. Talk about bad medicine.
Ironically my only visit to a rapid clinic (as opposed to an ER) I saw a PA for a large hematoma on my leg.
My most recent visit (about 13 months ago) was for my parotid gland swelling where I saw a NP. She diagnosed it as "cellulitis," which it wasn't. She prescribed an appropriate antibiotic. I saw my ENT friend the next day who diagnosed the parotitis and the salivary gland mass with a CT scan in his office. The NP gave the right antibiotic for the wrong diagnosis.
@George-K said in Did a doc even see this guy?:
@jon-nyc said in Did a doc even see this guy?:
It was a shame he didn’t see a doc but frankly both PAs should have caught this.
Absolutely. Talk about bad medicine.
Ironically my only visit to a rapid clinic (as opposed to an ER) I saw a PA for a large hematoma on my leg.
My most recent visit (about 13 months ago) was for my parotid gland swelling where I saw a NP. She diagnosed it as "cellulitis," which it wasn't. She prescribed an appropriate antibiotic. I saw my ENT friend the next day who diagnosed the parotitis and the salivary gland mass with a CT scan in his office. The NP gave the right antibiotic for the wrong diagnosis.
A broken clock is right twice a day…
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Here's the other thing I found interesting.
PAs and NPs usually do not work without supervision of some kind. The stories say that Lupold sued the hospital as well as the employer of the PA and NP. I would assume that some doc signed off on their diagnosis, and somehow, s/he was not sued?
If I were working with a CRNA, and things go south, leading to a lawsuit, you can bet that my name would be on the complaint. In fact, probably at the top.
About 10 years before I retired, I looked at a job north of the Cheddar Curtain. I was told that, although call was frequent, it was rare to have to come in. For simple cases and epidurals for labor, the CRNA would do the case, and I could sign the chart the next day. I ran away from that place.
@George-K said in Did a doc even see this guy?:
Here's the other thing I found interesting.
PAs and NPs usually do not work without supervision of some kind. The stories say that Lupold sued the hospital as well as the employer of the PA and NP. I would assume that some doc signed off on their diagnosis, and somehow, s/he was not sued?
If I were working with a CRNA, and things go south, leading to a lawsuit, you can bet that my name would be on the complaint. In fact, probably at the top.
About 10 years before I retired, I looked at a job north of the Cheddar Curtain. I was told that, although call was frequent, it was rare to have to come in. For simple cases and epidurals for labor, the CRNA would do the case, and I could sign the chart the next day. I ran away from that place.
NP's and PA's work under docs, but I think oversight is minimal, at best.
In short, it's a joke.
I don't know if I'd blame Medicare or Medicare+Medicaid, or throw Obamacare into the mix.
What I do know, is we need a bunch more docs. Not diversity, but sheer merit.
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The whole system sounds broken. I think that the US does need more doctors, but a lot of doctors say that they would think twice about becoming a doctor in todays world.
What do you guys think? @Jolly @George-K @bachophile
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Med school slots also require training slots in the hospital.
As for foreign docs, most are not as good as American docs. Secondly, the language barrier is real, even with guys who speak English as a second language. Fix problem #1, and you don't need them. Med schools turn down a bevy of qualified guys every year.
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Med school slots also require training slots in the hospital.
As for foreign docs, most are not as good as American docs. Secondly, the language barrier is real, even with guys who speak English as a second language. Fix problem #1, and you don't need them. Med schools turn down a bevy of qualified guys every year.
@Jolly said in Did a doc even see this guy?:
As for foreign docs, most are not as good as American docs.
Perhaps in your experience.
It might be location-related, but I saw plenty of shitty American-trained docs at the university, and plenty o good foreign-trained docs.
Of course, there's the possibility that a rural location might be more conducive to taking on foreign-trained docs.
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In my experience.
I worked primarily with Tulane residents, and those guys have a pretty good contingent of foreign born docs. After we went to mostly staff, we had a good many Indian guys, a smattering of black and white Americans, and all kinds after that, including Syrian, Brazilian, etc. Yes, some of the foreign born were good. Some were very good. And some of the native docs weren't.
In rural hospitals today, you see a good many foreign born docs, mostly Indian. At least down here. I'm basing that on working at a half-dozen rural hospitals doing side work over the last twenty years or so.
Stacking one total vs. the other, I don't think the foreign born guys are as good. Maybe it's because the rural areas draw less qualified doctors, if those doctors weren't raised there. Bright lights, big city, it ain't.
But I will stick with my original statement.
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In my experience.
I worked primarily with Tulane residents, and those guys have a pretty good contingent of foreign born docs. After we went to mostly staff, we had a good many Indian guys, a smattering of black and white Americans, and all kinds after that, including Syrian, Brazilian, etc. Yes, some of the foreign born were good. Some were very good. And some of the native docs weren't.
In rural hospitals today, you see a good many foreign born docs, mostly Indian. At least down here. I'm basing that on working at a half-dozen rural hospitals doing side work over the last twenty years or so.
Stacking one total vs. the other, I don't think the foreign born guys are as good. Maybe it's because the rural areas draw less qualified doctors, if those doctors weren't raised there. Bright lights, big city, it ain't.
But I will stick with my original statement.
@Jolly said in Did a doc even see this guy?:
In my experience.
That's my point.
You have probably had a wider experience of rural/semi-rural hospitals which, as you say, might draw more from foreign-trained docs.
My experience is 100% urban/suburban. The suburban place drew from a lot of other hospitals so it was pretty broad-based. Both places were non-discriminatory as to the percentage of idiots.
