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The patient in this case was a freshman at Northeastern University. At the beginning of the second semester, she was not feeling well so she saw a physician at the student health clinic. In fact, she visited the clinic six times during the winter of 1993. At those visits, she complained of chills, fatigue, sweating, shortness of breath, weakness in her legs, headaches and an inability to void. The doctor thought she suffering from fatigue and general malaise resulting from a viral syndrome and prescribed rest, fluids and Tylenol. Finally, she returned to clinic when she was so weak that a security guard and another student had to help her there. At that time, the clinic was being staffed by a registered nurse who performed a throat culture that was negative. The nurse diagnosed her with the flu. A doctor later reviewed the nurse’s notes and signed off on them.
Shortly after that appointment, the student went home and then returned to school. However, she continued to feel poorly and went home again. A visit with the family physician was arranged for March 2. However, on February 28, 1993, she collapsed and was rushed to the hospital. She did not regain conciousness and died several hours later. The cause of her death was anemia resulting from acute lymphoblastic anemia.
Her parents sued the University, the physicians and the nurse. They asserted that the defendants failed to appreciate the severity of her condition when she had visited them. Their experts asserted that a simple blood test would have established that she was suffering from anemia. This finding would have necessitated further work up which would have revealed the presence of the leukemia. Such early attention to these warning signs and earlier diagnosis would have afforded her the opportunity for life prolonging care including chemotherapy or bone marrow transplantation.
The Plaintiffs also raised several other issues at trial. At deposition, the physician who had signed off on the nurse’s notes in February testified that he had not reviewed her prior note before signing off. They implied that had he done so, he would have moved onto further testing, including blood work. Another issue regarded the role of the nurse in the patient’s care. The plaintiff asserted that the nurse had actually diagnosed the patient on her own and that this was a violation of Massachusetts law. Finally, one of the doctors testified that he had not been provided any training nor provide a booklet about its services. He testified that he did not know that blood tests could be performed at the health center.
The defense asserted two positions. First, their experts testified that, in light of the presenting symptoms, a blood test was not indicated and the diagnosis reached were reasonable and not negligent. They also presented testimony that the leukemia was fast moving and that earlier diagnosis would not have made a difference.
The jury found against the University but in favor of the physicians. They awarded the family four million dollars. However, because the University is a charity under Massachusetts law, the maximum judgment that could be entered was for twenty thousand dollars.
This case had significant repercussions in the way in which University health center are structured and staffed. It seems clear that since the jury verdict was only rendered against the university, they did not think the clinic was appropriately organized or staffed. Following this case, many such clinics are now staffed with nurse practitioners. Their licensure does allow for them to diagnose and prescribe medication in a physician’s absence. This case also raises questions about continuity and coordination of care. One of the physicians said that he had not read the patient’s prior notes before signing off on her care. Obviously, this raises the question of, if he had known what was in those notes, would he have done something differently. The policies of the infirmary should require that the patient’s preexisting record be available to the providers who see her on a particular date. This is especially true if the providers have not previously treated the patient. Finally, it is incumbent upon both the clinic to provide information to the professionals concerning what services are available on site and how other services should be provided to their patients. If such services require that the patient be seen at a hospital, then guidelines should be available which outline how the patient is to be transported there and back. By outlining these procedures in advance and informing the health care professionals how to provide these services, more consistent and better health care will be provided to their patients.
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