Details about incidents that occurred at a later time, after a decision was made, should never come into play when determining whether a provider’s decisions were appropriate for the circumstances.

Conclusions

The Panel concluded that the standard of care does not require that all patients with acute quadriceps tendon ruptures be admitted to the hospital.

While some may consider admission to a hospital a means to “protect” patients, admission to a hospital is not without both physical and financial risks.

Patients can have bad outcomes related to inappropriate admissions. Patients may suffer complications from false-positive testing. Sleep/wake cycles and dietary routines may be disturbed. Patients are often exposed to virulent organisms in a hospital setting and are at risk for developing infections resistant to ordinary antibiotics. Costs of admission may not be paid by insurers if medical necessity is not demonstrated, leaving patients with large medical bills.

Although bad weather and a patient’s living conditions may be considerations in a patient’s ultimate disposition, neither factor should always be case-determinative.

The Panel unanimously concluded that the provider in this case met or exceeded the standard of care in managing this patient.

This entire case review and several others can be found on www.ACEP.org under Practice Resources in the category “Standard of Care Review.”

Any ACEP member aware of questionable testimony regarding the standard of care for emergency physicians, be it by experts for the defense or plaintiff, can consider sending the testimony to the Standard of Care Review Panel. Visit the ACEP Web site for more information about the process and how to submit questionable testimony.