Read & Test

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Surgeon Assumes Supplemental Report is Copy of Prior Report

ISSUE: What is a physician's duty to ensure that every laboratory or consultant's report is reviewed?


An internist diagnosed and began treating a 46-year-old woman for Polycythemia Vera. The internist prescribed a therapeutic phlebotomy. He ordered the procedure and sent her to the blood bank at the medical center where he was employed. When the procedure was completed, an elastic bandage was placed over the venipuncture site. A short time later, the patient experienced pain and swelling under the bandage. She notified the phlebotomy nurse who removed the bandage, examined the swelling, and noted that the area of swelling was larger than she had seen in her five years of experience. She called the internist who briefly looked at the patient's arm, told her that "the whole thing is going to turn black," and walked out of the room. The nurse subsequently gave the patient a prescription for pain medication and escorted her out of the center shortly after 5 p.m.

The patient's arm continued to swell and became increasingly painful throughout the night. The next morning, the patient's son drove her to the emergency department where she was diagnosed as having an arterial laceration and a compartment syndrome. The compartment syndrome had progressed to the point that the patient required a fasciotomy to relieve the pressure in her arm. The incision required 47 staples to close. She remained at the hospital for six days before moving to a rehabilitation center where she remained for a month, attempting to regain some of the functioning in her right hand.

The patient sued, alleging that the internist should have either: (1) kept her at the clinic for observation, (2) placed her in a hospital for observation, (3) ordered a duplex scan of her arm, or (4) provided her with sufficient post-procedure instructions. She claimed that had any of these steps been taken, she could have alerted medical personnel to her condition before it progressed. The physician argued that bleeding and a hematoma at a venipuncture site were so common that further examination was unnecessary, even after the nurse's report.

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From your analysis of the case, assess whether the following statements are true or false: