Chapter 20: You Were Proud of Me!

April 30, 1990, McKinley, Ohio

"Thanks for not throwing me under the bus," Paul Lincoln said when I arrived in the ED on Monday morning.

"What I said was the honest truth," I replied. "Nothing that happened in the ED was responsible for the patient coding on the table following surgery. As far as I'm aware, nothing that we might have done would have prevented the outcome. He was unlucky. The mortality rate attributed to anesthesia is around eight per million, or less than one per 100,000 surgeries. That's down significantly from the 50s, when it was something like sixty per 100,000. Anything for me?"

"Diabetic abscess in Exam 3, waiting on Medicine; concussion in Exam 2 with stable vitals being monitored until 6:00am. That's it."

"Then I'll see you tomorrow morning!"

He left, and Mary came out of the lounge.

"Morning!" she exclaimed. "I'm ready to go."

"Then get a chart, and let's get to work."

We saw seven patients, admitted the diabetic abscess, and streeted the concussion. Just before 9:00am, Nate let me know that Mr. Crowe wanted to see me. I had a sinking feeling as I made my way upstairs to the admin wing. Mr. Crowe's secretary sent me right into his office.

"Morning, Mike."

"Morning, Leland. Malpractice suit?"

"Unfortunately, yes. I was served this morning with a suit and a subpoena for medical records and charts. I believe as soon as those are tendered, you, Dutch Wernher, Paul Lincoln, Chuck Boyd, Ross Burnside, and John Flynn will all be named personally. Right now, you're all referred to as 'unknown medical staff'."

"Wonderful."

"The hospital will defend you, but you have the right to have personal counsel. If you want to confer with Miss Coates before you answer my next question, I'll understand."

"I have no practical objection to a settlement with no admission of liability. Philosophically, I object, but I understand that a settlement is the pragmatic course of action."

Mr. Crowe laughed, "You were the one I was worried about."

"Honestly? We should win this one, hands down. But a jury will see an otherwise healthy male in his mid-thirties who died at our hands, and nothing you say will be able to dissuade them from holding us responsible, even if there was literally nothing else that could have been done."

"Exactly right. If they were to go to a Medical Review Board, they'd dismiss it immediately as 'one of those things'. By the way, please do NOT use the phrase Doctor McKnight used in the M & M."

I chuckled, "It did sum everything up quite nicely, but I understand, and I won't."

"Thanks. Will you accept service via me?"

"Yes. It's silly to have a process server try to serve me in the ED."

He slid a form across his desk.

"Read this and sign it, please. You're doing nothing except agreeing to service via the hospital's legal counsel, that is, me."

I read the form, and it was quite clear that it was solely to allow the plaintiff to serve me and that no other power was granted. I signed and dated it and handed it back to Mr. Crowe.

"Anything else I need to be concerned about at the moment?" I asked.

"No. Between you and me, you and Mary Anderson are the only ones completely in the clear. The true attack will be against Paul Lincoln and Ross Burnside. In fact, the last thing the plaintiff's counsel would want to do is put you on the stand because you moved with alacrity and made the correct diagnosis, then got him into surgery."

"I have to ask..."

Mr. Crowe smiled wryly, "Same church, different pew, as it were. The attorney is Amanda Temple, a partner at Volstead & Braun."

"Wonderful. Will Mary be named?"

"It's unlikely. To name a medical student, they'd have to prove that the student took some specific action he or she was prohibited from taking and which was contrary to best medical practices. That said, Miss Anderson assisted with the surgery, so it's possible. In cases such as this, it's Anesthesia with their butt hanging in the breeze, which is why their malpractice rates are so much higher than any other specialty except neurosurgery."

That made sense, given that there were significant adverse reactions to anesthesia, though those rates were coming down significantly, as I'd noted to Paul earlier in the day.

"I heard bitching from the OB Residents that their rates are going up significantly."

"You mentioned how juries respond to healthy men in their mid-thirties dying; imagine a baby."

"Out of curiosity, what would have happened had things gone south with the baby I delivered?"

"Nothing good, that's for sure," Mr. Crowe said. "That's why it's now a dismissible offense for the on-duty Attending to fail to send at least an OB nurse to the ED upon request, and then, that's only acceptable if every Resident is mid-delivery."

"I knew about the new policy but not the potential punishment."

"The liability if something goes wrong is effectively unlimited. It's whatever the plaintiff can convince the jury to return, and no matter how much it is, no judge is going to reduce the award for what I think are obvious reasons. We settled a case about two years ago for a million dollars. We got off cheap."

"I didn't hear about that."

"It was settled before the suit was filed, and the settlement was private."

"It must have been a firm other than Volstead & Braun. That's not their style."

"No, it's not. And you're correct."

"I need to get back to the ED. I'll call Melody and speak to her, but I won't retain her at this point."

"OK. I'll keep you posted."

I left his office and returned to the ED.

"What's up?" Mary asked.

"A malpractice suit over the hot appy who coded on the table."

"I'd say we didn't do anything wrong, but I suspect that doesn't matter."

"You suspect correctly," I confirmed. "Right now, it's just the hospital, but they sent a subpoena for charts and records, so I expect to be named, along with Doctors Lincoln, Boyd, Wernher, Burnside, and Flynn."

"What about me?"

"Anything is possible, but you and I are probably the only ones who are completely safe from any negative fallout. Paul was unlucky; Burnside is the most likely to be the main target."

"What happens now?"

"We wait. The hospital will offer a settlement with no admission of liability, and if they take it, that'll be the end, given everything I heard in the M & M. Sure, someone could file a complaint with the State Medical Licensing Review Board, but you were in the OR — what did anyone do wrong?"

"Nothing. It was almost exactly like the textbook."

"Bingo. And you heard McKnight say that he reviewed all the drugs used, and there were no contaminants, and they were authentic. His stated analysis was correct, though 'one of those things' is a better way to say it in public. Don't worry about it. Chalk it up to bad luck, fate, karma, Satan, or whatever you wish, and get the next chart."

"Who or what do you blame?"

"Imperfect knowledge of human physiology. We know a lot, and I mean a tremendous amount. We don't know even more. It's my friend Robby's job — Sophia's husband — to work on that."

"He's going to teach and do research at Stanford, right?"

"Yes. Get the next chart, please."

"Hold up on that!" Nate called out. "EMS three minutes out with multi-victim MVA. Trauma 3 and 4 are open. I'll notify Doctor Casper and Doctor Townshend."

"Let's go, Mary," I said.

We hurried towards the ambulance bay, donning gowns, gloves, and goggles, and Kellie joined us in the ambulance bay, with Sue Townshend and her two students and Ghost joining us.

"Two victims," Ghost announced. "One in very bad shape. Mike and I will take that one in Trauma 2; Sue, you take the other one in Trauma 3 and ask for Doctor Wernher if you need help."

We acknowledged him and waited for the approaching EMS squads to arrive, which they did about a minute later. Bobby jumped out of the squad.

"Jane Doe, about twenty; restrained head-on, high-speed MVA with lengthy extraction. Tachy at 120; BP 90/60; intubated PO₂ 92%; GCS untestable; neck brace and backboard; crush injuries to both legs; abdomen rigid; severe laceration of left temple; IV saline TKO."

"Trauma 3!" Ghost declared. "Mike, surgical assessment; Kellie, full trauma panel; Mary, EKG and monitor. Move!"

We began moving, and I called out to Ellie that I needed an ultrasound. GCS reported at 'untestable' was a result of being intubated and having no response to pain. In the trauma room, Bobby and Sam helped us move the patient to the trauma table, and everyone sprang into action. Nurse Jackie quickly cut away the patient's clothes, and Ghost and I began our exams.

"Belly is rigid," I announced. "Flail chest."

"Left pupil is blown," Ghost announced.

"PVCs!" Mary announced. "Run of seven."

I auscultated the patient's chest and announced, "Muffled heart sounds! Kellie, syringe with cardiac needle and an alligator clip!"

"PEA!" Mary announced.

Kellie handed me the syringe, and as quickly as I could, I performed a blind pericardiocentesis and aspirated pinkish fluid, filling the syringe.

"Blood in the pericardium," I announced. "Kellie, catheter and valve to me!"

"Weak heartbeat," Ghost announced.

"She needs surgery, but we need to stabilize her," I announced.

"Tell me something I don't know!" Ghost growled, but I knew it wasn't directed at me. "Leslie, call for a stat neuro consult!"

I inserted the catheter to drain fluid from the pericardium.