Case here: https://expertwitness.substack.com/p/hospitalist-recommends-discharge
tl;dr
54-year-old woman seen at outpatient clinic, first visit in decades, for vague malaise, SOB, abd pain. Tachycardic in 120s.
Labs show leukocytosis, hyperglycemia, bicarb 14, anion gap 21.
NP calls a nearby hospital. She claims she told the hospitalist all of the lab info and vitals. He claims she just asked what she should do in general with the patient and he said discharge her on diabetes meds.
NP talks to her supervising doc, who says I guess if they won’t admit, then send her home.
She goes home and promptly dies, autopsy shows staph bacteremia.
The lawsuit was really interesting… the hospitalist claimed he had no legal duty to the patient since he never saw her. The judge initially agreed and he was dismissed, but the Supreme Court overruled and decided you don’t have to have a direct patient-doctor relationship to have a legal duty. Hospitalist went to trial, but the jury was hung. They ended up settling rather than going through another trial. The NP and supervising doctor also settled.
This lawsuit helps clarify that if you give advice over the phone, even without seeing the patient, you have established a duty to that patient.
Probably for the best in situations like this to have the patient sent to the ED so the hospitalist can see them in person. Way way way too much risk to refuse over the phone with an NP you’ve never met and no way to actually see the labs and vitals yourself.