In this case, the patient was evaluated, diagnosed with a patellar tendon rupture, immobilized, and given crutch training.

In addition, an orthopedist evaluated the patient in the emergency department, performed an arthrocentesis, and deemed the patient stable for discharge, instructing the patient to follow up at his office as an outpatient.

While the expert witness stated that the standard of care required admission of the patient for immediate surgery and pain control, delayed surgical care after brief outpatient management is common in community hospitals, and the chart clearly showed that immediate repair of the quadriceps tendon rupture was not planned.

Furthermore, the emergency department records showed that the patient’s pain rating at the time of discharge was a 3 on a scale of 1 to 10, refuting the expert’s assertion that admission for “pain control” was warranted.

The expert witness made statements to the effect that “bad weather” and a “snowy day” created an undue risk of injury to such a patient, and the standard of care therefore necessitated the patient’s admission.

However, the Panel was unable to find any literature advocating that patients be admitted because of bad weather.

the standard of care does not require that all pa­tients with acute quadriceps tendon ruptures be admitted.

Requiring admission until weather was “acceptable” or until snow has melted from the ground could conceivably result in the requirement that all patients be admitted to hospitals for several months in some regions during winter to avoid a purported undue risk of injury.

The expert witness stated that the patient should have been admitted to the hospital because he would have to ascend stairs in his home to use his bathroom.

Again, the Panel was unable to find any literature suggesting that all patients with crutches should be admitted to the hospital if they might have to ascend stairs on discharge. Taking this requirement to its logical conclusion would also require prolonged admissions of any patients on crutches who live in multilevel housing.

In several instances during the proceedings, the expert witness referred to what the expert personally would have done in that situation. However, courts universally have rejected a standard based on expert witnesses’ personal preferences.

Rather, the standard of care should be based on what a reasonable physician would do under the same or similar circumstances—based on the information known at the time the decision was made.