Question

Jack is a 4-year-old boy with a known peanut allergy. On September 15, 2016, Jack’s parents took him to the nearby, but small, Maplewood Community Hospital emergency department for evaluation of a suspected allergic reaction. Jack’s parents reported that he developed facial swelling, tongue swelling, and a diffuse red rash over his entire body immediately after eating what was “labeled” as an almond butter cookie. Before arriving at the ED, Jack’s mother administered oral diphenhydramine at the onset of his symptoms, without any apparent improvement. At the Maplewood ED, initial physical examination was significant for diffuse facial edema including the lips, tongue edema, and a diffuse urticarial rash on the chest, back, arms, and legs. Jack was treated with epinephrine intramuscularly, methylprednisolone intravenously, diphenhydramine IV, and ranitidine IV. Rash and tongue edema were unchanged, and facial edema improved. While Jack was being examined and treated at the ED in the presence of his father, his mother was waiting in the Maplewood Community Hospital cafeteria. During this time, Jack’s mother became dizzy and unsteady on her feet. She made her way back to the ED. There, staff noted that she was slurring her speech and exhibiting left facial droop, both signs of a stroke. Triage nurses and physicians performed standard diagnostic tests which included stroke assessments, an electrocardiogram, and a computed tomography (CT) scan. None of these tests indicated evidence of stroke (like intracranial hemorrhage). So, the staff diagnosed her with Bell’s palsy, a form a temporary facial paralysis unrelated to stroke. Jack’s mother was discharged. Jack’s mother is somewhat of a celebrity in Maplewood Community. She is a well-known video blogger and Instagram celebrity. When some of the staff at Maplewood Community Hospital heard she was in the hospital they wanted to know why since there had been rumors for a long time that she was a “speed freak”. Several nurses and physicians not on her treatment team accessed her chart and one physician sold the information he obtained from her record to TMZ.

Meanwhile, after her initial examination of Jack, the Maplewood ED attending physician telephoned the ED attending physician at Saint Paul Children’s Hospital to discuss transfer for specialized pediatric care (unavailable at Maplewood Community Hospital) for a presumed allergic reaction. The Saint Paul Children's Hospital physician agreed to accept the patient transfer request. Maplewood then contacted a private ambulance service for patient transport. Copies of the medical records were made and handed to the ambulance crew at the time of transport. But the private ambulance service then transported Jack to Edina Children’s Hospital instead of Saint Paul Children’s Hospital. On arrival at Edina Children’s Hospital, Jack was evaluated and noted to have obvious facial edema and a generalized urticarial rash. No intraoral edema or respiratory distress was present at the time of arrival. The medical team at Edina Children’s Hospital recommended admission to the hospital for further evaluation, monitoring, and treatment. After determining that Jack had been transferred from Maplewood Community Hospital, the Edina Children’s Hospital ED charge nurse telephoned Maplewood Community Hospital to inquire about the transfer, including why no advance communication about the transport had occurred. The Maplewood Community Hospital charge nurse explained that the transfer had been intended for Saint Paul Children's Hospital. She then alleged that Edina Children’s Hospital had committed an EMTALA violation by treating Jack rather than immediately transferring Jack to the intended destination at Saint Paul Children’s Hospital. The Edina Children’s Hospital ED attending physician then arranged for Jack’s transfer to Saint Paul Children’s Hospital. A subsequent review revealed that the private ambulance service had dispatched its personnel with incorrect destination information. But none of the three hospitals led any formal complaint about each other or about the ambulance company. Jack was soon discharged from Saint Paul Children’s Hospital and is now doing fine.

Unfortunately, Jack’s mother did not fare as well. She died from a stroke on October 3, 2016. The coroner determined that her right carotid artery must have been so seriously occluded on the date of her visit to Maplewood Community Hospital, that she suffered a first stroke at that time. Therefore, ED clinicians there should have been administered the appropriate therapy (tissue plasminogen activator) to dissolve blood clots.

You are a Healthcare Administrator at a local hospital and Jack’s father comes to you for help because he knows you are a healthcare expert. He wants to know whether he has a wrongful death claim against Maplewood Community Hospital and whether you think any of the hospitals committed EMTALA violations. He also wants to know if you think a privacy violation occurred and if one did occur who he should file a complaint with. Moreover, he doesn’t like the way the malpractice system works in his State and would like to lobby the State legislature to make changes. Since you are a healthcare expert he would like your opinion on what changes should be made to the current malpractice system in the United States. He feels that he shouldn’t have to file a lawsuit against Maplewood for them to take ownership of misdiagnosing his wife. Finally, while he is down lobbying for malpractice reform he also wants to discuss changes to the privacy rule with the state legislature and wants your opinion on what might be changed so his wife’s privacy might have been better protected while she was in the hospital. He asks that you prepare a memo with all the requested information in it so he can evaluate his next steps.

Answer 1