Complaint rebuttal and discussion:
Dr. Hospitalist-Consultant testified that he called the surgeon after the consult and they discussed a "surgical complication" as a possible cause of the symptoms. There was no chart documentation that this call occurred. Although the impression section of the consult note did have "? Surgical complication," Dr. Hospitalist-Consultant did not elaborate further in his notes or during his sworn testimony as to what surgical complications he was considering.
Dr. Neurosurgeon 2 had no memory of this conversation, and he admittedly never saw Mrs. G at all. Dr. Neurosurgeon 2 was covering three hospitals that Saturday, and he was in the operating room at another facility at the time of the initial nurse contact about Mrs. G until about 11 p.m. that night.
Dr. Neurosurgeon 2 did testify that if he had been told about Mrs. G’s clinical exam, he would have asked Dr. Hospitalist-Consultant to obtain a CT of the neck. Dr. Hospitalist-Consultant testified that he did not remove the cervical collar because it was ordered by surgery, and he expected the surgeon to examine the incision. Dr. Hospitalist-Consultant further testified that he was unaware that Dr. Neurosurgeon 2 was not able to come and see Mrs. G. and assumed that Dr. Neurosurgeon 2 would take care of his patient. Dr. Hospitalist-Consultant was adamant that he had palpated Mrs. G’s face and that crepitance was not present.
The plaintiff argued that somebody had the responsibility to fully examine Mrs. G and arrive at the appropriate workup and treatment. The plaintiff was critical of Dr. Hospitalist-Consultant for not checking with the surgeon about removing the collar and not recognizing that he was the only physician that was available to attend to Mrs. G that Saturday afternoon/evening. The plaintiff also found the "allergic reaction" diagnosis unreasonable under the circumstances and the lack of crepitance implausible.
Conclusion:
Hospitalists are frequently asked to see postsurgical patients. In fact, many surgeons routinely consult hospitalists for "postoperative medical management." It is important for both the surgeon and the hospitalist to clarify lines of responsibility. In this case, the hospitalist assumed that the surgeon was going to take care of the "surgical issues." However, the surgeon was expecting Dr. Hospitalist-Consultant to perform a full postsurgical assessment, including knowledge of surgical complications.
Conversations among physicians engaging in surgical co-management should be documented including a delineation of responsibility. Had Dr. Hospitalist-Consultant done this, he may have avoided this lawsuit altogether. Ultimately, the jury in this case did not fault any of the providers as a full defense verdict was returned.
Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He reported having no relevant financial conflicts.