ONLY EXPERTS PRACTICING IN NEW YORK STATE WILL BE ABLE TO POST A COMMENT
66 y/0 obese woman w/ hx of hypertension and hyperlipidemia, goes to her PCP on 4/8/21 for medical clearance for a total hip replacement on 4/14/21. He does no blood work, but relies on labs from 8/6/20, 8 months earlier. That Potassium level was 3.6 (3.5-5.3=nml). Does an ekg in office and result is "no interpretation due to signal problem." On 4/14/21 Orthopedist does total hip. When transferred to stretcher the pt. codes, v-fib is noted, and she does not respond to recitation meds. Transferred to Hospital by EMS. Cardiology consult there states "V-fib potentially related to hypokalemia, 2.1 on ED labs." My questions:
1. Is PCP iiable for failing to do timely blood work and a readable ekg?
2. Is Orthopedist liable for failing to make sure these tests were actually done before operating?
3. Is Surgi-Center liable for failing to make sure these tests were done before allowing operation to go forward?
Thank you.
Files:
No questions yet!
Do you believe there might have been medical error?
When obtaining preoperative clearance, the surgeon and the surgery center are relying heavily on the primary care doctor to certify that the patient is optimized for surgery. Considering the volume of patients an orthopedic surgeon and an anesthesiologist work on in a given day, as well as the scope of their training and practice, it is unreasonable to expect them to thoroughly comb through each chart that an internist has already signed off on as "cleared". The onus falls primarily on the primary care provider, in a case like this, to ensure that the patient is indeed optimized for the procedure. The recentness of laboratory tests and the accurate reading of any testing are the responsibility of the person who is signing off on the patient as cleared. Orthopedic Surgeons do not have the experience nor training to catch an error like this. The anesthesiologist reviewing the case also could have potentially caught this, however it's mostly the responsibility of the medical doctor. Even though the readout on the EKG may have said "no interpretation due to signal error," it is possible that the PCP was able to manually interpret the EKG. Reliance on automated interpretation is not considered professionally acceptable by most internists and cardiologists, thus it is often disregarded. Thus there is not definitely error here. There is potential for a defensible position. The labs are also, while possibly dated, just a snapshot in time. It's possible they were trending up over time, or very stable for the prior decade.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The medical clearance was insufficient, and knowledge and correction of the potassium deficiency could have prevented this problem. It is not certain, however, since the v-fib was only "potentially" related to the hypokalemia, according to the cardiology experts, and not definitely related to it. It's also possible the patient simply had an MI or there was another event that caused the v-fib unrelated to the hypokalemia. We do not have enough information to definitively say.
What makes you a good expert for this case?
I am an orthopedic surgeon who regularly performs elective bone and joint procedures, and routinely confers with medical doctors to obtain preoperative medical clearance for patients who need it.
How often do you encounter cases similar to this one in your practice?
Thankfully very rarely. I do perform elective cases all the time, but this particular situation is very uncommon.
Do you believe there might have been medical error?
Preoperative clearance is more important than the elective surgery. itself. Obtaining preoperative clearance is a responsibility of both the referring Ortho surgeon and the PCP performing the clearance
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The most likely cause of the peri-op V-Tach was the laboratory and ECG abnormalities
What makes you a good expert for this case?
I am a board-certified orthopaedic surgeon with 26 years of clinical experience. I have been obtainng preop clearance for all 26 years.
How often do you encounter cases similar to this one in your practice?
I encounter cases such as this on a daily basis in my practice.
Want to open a case or submit response?
Comments are accepted only from Orthopaedic Surgery - includes all subspecialties experts.
Comments are accepted only from experts practicing in the following States: NY.