A patient with a potential post-operative complication should not be terminated until the complication is resolved.
Case File
A 23-year-old patient with cervical dysplasia underwent an uncomplicated loop electrosurgical excision procedure (LEEP) by OB 1, with whom she had an established relationship. Two weeks after the procedure, she presented to the ED with severe abdominal pain. She was diagnosed with an infection associated with the LEEP procedure, prescribed antibiotics and discharged when her pain subsided. She was told to follow up with her OB.
The patient was given an appointment the next day with OB 2, OB 1’s partner. She was no longer in pain and the exam findings were normal. OB 2 told the patient to follow up in one month, or earlier if her symptoms returned. A week later, the patient again presented to the ED complaining of abdominal pain. She was discharged without a definitive diagnosis when her pain subsided, and she was told to follow up with her OB. The next day she called the clinic and demanded to be seen by OB 1. OB 1 did not have an appointment available for several weeks. When she was offered a same-day appointment with OB 2, she became angry and criticized the clinic, its OBs and staff. Because of her behavior, the next day OB 1 sent a certified letter to the patient, formally dismissing her from the practice. In the letter, he offered to provide emergency treatment for 15 days. When the patient received the letter, she called the OB’s office threatening to file a lawsuit if he did not give her an appointment, which he refused to do.
The patient quickly found a new OB, who diagnosed cervical occlusion as a result of the LEEP procedure. Shortly after the diagnosis, she underwent hysterectomy and oophorectomy. She filed a lawsuit against OB 1 alleging patient abandonment and failure to timely diagnose cervical stenosis.
Discussion
At trial, the patient’s expert testified that OB 1 should not have attempted to dismiss the patient without speaking with or examining her. The defense expert testified that OB 1’s treatment was entirely within the standard of care. However, he acknowledged that dismissing a patient who was potentially suffering a surgical complication would likely be criticized by the plaintiff’s experts. The case ended in a plaintiff’s verdict.
Medical Liability Risk Management Recommendations
Consider the following recommendations help reduce the risk of a patient abandonment lawsuit:
- Do not dismiss a surgical patient who may be experiencing post-operative complications.
- Offer to discuss the patient’s grievances prior to initiating dismissal proceedings.
- Make sure appointment scheduling protocols allow for timely scheduling of patients who may need “same-day” appointments.
- Communicate appointment scheduling policies to patients, including how to obtain care when patients are experiencing unexpected symptoms or need after-hours treatment.
