Learning Points

The initial approach to intubation was challenging due to a precipitous arrival to the emergency department and the fact that there were no appropriate rooms available. Without the correct setting and tools, no physician can be successful. Administrators and directors are responsible for putting physicians in a position to succeed. The decision to rapidly proceed with nasal intubation and without rapid sequence intubation (RSI) medications is suspect. Instead, giving bag-valve mask-assisted ventilations while IV access was established and RSI medications were prepared may have temporized the situation and permitted the possibility of a better outcome. That said, moving to a King Airway or supraglottic device shows the physician had a backup plan, which should always be in the forefront of the mind when performing an intubation.

The patient’s transfer proved challenging for the emergency physician. He made numerous calls to several institutions before eventually sending the patient to the first hospital he had called. This prolonged delay did the patient no favors. Physicians working in large medical centers sometimes have difficulty understanding the situation in rural emergency departments. They should keep in mind the challenges of working in a small hospital with limited resources. There have been numerous lawsuits that involved determining precisely when a consulting or receiving physician establishes a patient-doctor relationship. The issue is murky and can vary in different states and by the facts of the case.

Finally, this case involved an alleged EMTALA violation as opposed to standard medical negligence. As demonstrated in this instance, an EMTALA lawsuit brought by a patient against an individual physician is unlikely to succeed. However, this does not mean that doctors are free from punishment for EMTALA violations. The Centers for Medicare and Medicaid Services and the Office of the Inspector General have enforcement powers that include fines up to $50,000 for physicians.

This case also illustrates the false security of the idea that “you can’t be sued for that.” You can be sued for anything, and even if you are correct, the process is unpleasant. Despite Dr. H’s ultimate vindication, he undoubtedly had numerous meetings with attorneys, spent hours in depositions, and felt a lot of stress over the multiyear course of the lawsuit—and his attorneys certainly did not work for free. 

Dr. Funk is a practicing emergency medicine physician in Springfield, Missouri, and owner of Med Mal Reviewer, LLC. He writes about medical malpractice at www.medmalreviewer.com.