Firm helps medical doctor avoid discipline for treatment of patient in ‘close case’
Issue: A medical doctor faced professional discipline related to his examination of a woman who died from streptococcus pneumonia a few days after the examination.
Challenge: Unusual medical facts characterized the case, which largely turned on competing medical expert opinions about whether the doctor’s treatment met the reasonable standard of care.
Solution: Following a three-day hearing at the Massachusetts Division of Administrative Law Appeals, an administrative magistrate determined that the Massachusetts Board of Registration in Medicine failed to prove that the doctor’s treatment fell below the standard of care.
In 2013, the doctor examined a 41-year-old woman experiencing a fever, rash, and diarrhea. She also complained of having very cold upper and lower extremities and presented discolored skin in her toes, hands, and cheeks.
The doctor diagnosed Raynaud’s disease – which is severely restricted blood flow to affected areas – and instructed the woman to seek further medical attention if her condition did not improve or worsened.
She passed away a few days later from streptococcus pneumonia.
Characterizing the underlying facts as a “close case,” the magistrate found the medical expert opinion supporting the doctor’s defense more persuasive than the conflicting expert testimony on behalf of the Board.
The explanation by the doctor’s expert “that it is possible for a patient to be infection-free one day, and then have an infection the next day, is the most reasonable explanation of what occurred,” the magistrate wrote.
The medical expert who testified on behalf of the Board emphasized the fact that the woman had her spleen removed in 1993 because of a motor vehicle accident. Because an absent spleen could increase the likelihood of an infection, the doctor should have tested for an infection, the expert testified.
However, the expert was also forced to concede on cross-examination that the woman’s temperature, respiration, blood pressure, pulse oximetry, pulmonary exam, and cardiac exam were not consistent with pneumonia or sepsis, or even an infection.
As a result, the magistrate determined that the Board failed to demonstrate that the prevailing standard of care requires testing for a bacterial infection solely because a patient is more susceptible when the information at time of an examination does not otherwise indicate a bacterial infection.
Accordingly, the magistrate concluded – and the Board subsequently affirmed – that the doctor’s treatment met the standard of care. The Board adopted the magistrate’s conclusion and dismissed the professional disciplinary charges.
Attorney: Paul Cirel