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Yeah I came here to write more or less this exact comment -- the doctor absolutely did make a medical judgement on the patient, and frankly it was an astonishin

Yeah I came here to write more or less this exact comment -- the doctor absolutely did make a medical judgement on the patient, and frankly it was an astonishingly bad one. To declare, sight unseen, that a patient with several severe signs of infection is simply prediabetic, is negligent in the extreme, especially when the medical professional who is actually with the patient doesn't agree.

amputect 7y ago
Also I'd like to point out that the headline is, at best, highly misleading -- the doctor didn't see the patient, no, but that's the problem not an exculpatory factor. This isn't a random doctor being sued by a random patient it's a doctor whose medical judgement arguably led to the patient's death.
maxxxxx 7y ago
I am sure they dream of AI diagnosis. It can be optimized for profit and any negative effects can be blamed on the AI.
- ska 7y ago
  It's more the other way around, at least in a US context. Concern of the impact of AI/physician disagreement is a problem from a malpractice point of view. Physicians in the US have a huge amount of professional leeway - hence the expansion of off-label use - but this is counterbalanced by a large amount of professional responsibility/liability.
hn_throwaway_99 7y ago
Moreover, the Dr's argument that he was just "giving an opinion", but did not actually accept or prevent her admittance, absolutely does not pass the smell test. He was in a position of power, and from the description of the phone call with the nurse practitioner in the article it is extremely clear he wasn't just "offering an opinion", but was in fact denying admittance. Honestly, I feel awful for the patient and her family, but I also feel awful for the NP who tried to do the right thing but was shot down by those with greater seniority than her. I hope her employer changes their training so that if something like this happens in the future that they just tell the patient to go directly to the ER.
- Scoundreller 7y ago
  And to better assert the independence of NPs. At least with this lawsuit and settlement, NPs may be more legally motivated to do the right thing.
  - arkades 7y ago
    The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't. "Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?
    - Scoundreller 7y ago
      I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN). The NP settled their case out-of-court. So they were held liable, and we don’t know how much. The consulted MD felt like fighting it in court, and lost. That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.
      - arkades 7y ago
        It depends on how many hours they've practiced. Initially, under a physician. Eventually, completely independent. The article describes the second doc as a "collaborating physician," but I went to the underlying court documents and, no, they were just a second informal consult - this NP was practicing independently. The case isn't that unusual. Malpractice lawyers name everyone even tangentially related to a case, because malpractice insurance has a cap on payouts and you'll never go to court and win more than that cap, so you want to pull in as many people's policies as possible. Everyone that wasn't directly involved in the care of the patient gets their names dropped from the suit pretty quickly. Normally. So, it's not unusual that the person that actually fucked up (the NP) settled, and someone not part of the patient's care said screw that (the MD). Docs also don't choose for themselves whether they fight it in court. The malpractice insurer does. If you go against the insurer's wishes, you basically give up your malpractice coverage. In this case, I'm guessing that the fact that this is a slam-dunk "get thrown out of court" situation is why they didn't settle, as they do the vast majority of the time, regardless of the underlying merits of the case. Usually settling is cheaper than litigating, but a single "get this thrown out" motion is cheaper than settling. The unusual thing here is just that MN is somewhat unique as one of the few states that doesn't explicitly require a doctor-patient relationship for its malpractice suits, so instead of getting thrown out, the case is going ahead.

amputect 7y ago

Also I'd like to point out that the headline is, at best, highly misleading -- the doctor didn't see the patient, no, but that's the problem not an exculpatory factor. This isn't a random doctor being sued by a random patient it's a doctor whose medical judgement arguably led to the patient's death.

maxxxxx 7y ago

I am sure they dream of AI diagnosis. It can be optimized for profit and any negative effects can be blamed on the AI.

ska 7y ago
It's more the other way around, at least in a US context. Concern of the impact of AI/physician disagreement is a problem from a malpractice point of view. Physicians in the US have a huge amount of professional leeway - hence the expansion of off-label use - but this is counterbalanced by a large amount of professional responsibility/liability.

hn_throwaway_99 7y ago

Moreover, the Dr's argument that he was just "giving an opinion", but did not actually accept or prevent her admittance, absolutely does not pass the smell test. He was in a position of power, and from the description of the phone call with the nurse practitioner in the article it is extremely clear he wasn't just "offering an opinion", but was in fact denying admittance. Honestly, I feel awful for the patient and her family, but I also feel awful for the NP who tried to do the right thing but was shot down by those with greater seniority than her. I hope her employer changes their training so that if something like this happens in the future that they just tell the patient to go directly to the ER.

Scoundreller 7y ago
And to better assert the independence of NPs. At least with this lawsuit and settlement, NPs may be more legally motivated to do the right thing.
- arkades 7y ago
  The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't. "Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?
  - Scoundreller 7y ago
    I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN). The NP settled their case out-of-court. So they were held liable, and we don’t know how much. The consulted MD felt like fighting it in court, and lost. That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.
    - arkades 7y ago
      It depends on how many hours they've practiced. Initially, under a physician. Eventually, completely independent. The article describes the second doc as a "collaborating physician," but I went to the underlying court documents and, no, they were just a second informal consult - this NP was practicing independently. The case isn't that unusual. Malpractice lawyers name everyone even tangentially related to a case, because malpractice insurance has a cap on payouts and you'll never go to court and win more than that cap, so you want to pull in as many people's policies as possible. Everyone that wasn't directly involved in the care of the patient gets their names dropped from the suit pretty quickly. Normally. So, it's not unusual that the person that actually fucked up (the NP) settled, and someone not part of the patient's care said screw that (the MD). Docs also don't choose for themselves whether they fight it in court. The malpractice insurer does. If you go against the insurer's wishes, you basically give up your malpractice coverage. In this case, I'm guessing that the fact that this is a slam-dunk "get thrown out of court" situation is why they didn't settle, as they do the vast majority of the time, regardless of the underlying merits of the case. Usually settling is cheaper than litigating, but a single "get this thrown out" motion is cheaper than settling. The unusual thing here is just that MN is somewhat unique as one of the few states that doesn't explicitly require a doctor-patient relationship for its malpractice suits, so instead of getting thrown out, the case is going ahead.