Page 52 - 2021 Risk Reduction Series - Communication Part One

SVMIC Risk Reduction Series: Communication

heart palpitations. She was admitted by Dr. Richard

Williams, a hospitalist, and evaluated by Dr. Morgan Patel,
a cardiologist, who found no acute etiology for her

symptoms. Nursing notes indicated fetal heart tones were
detected at each shift, but no non-stress test, fetal

evaluation, or evaluation for pre-eclampsia was done.
Before she was discharged, Dr. Radley requested she

come to the office three days later to assess for induction.
When she arrived for such assessment (personal effects

for impending hospitalization in hand), Dr. Radley’s
receptionist informed her that without verifiable insurance

coverage, she would be required to make a substantial
payment before being seen by Dr. Radley. Unable to pay,

Ms. Diaz left without being seen. No physician or clinical
staff were notified. Four days later, she appeared for an

office visit, but there were no fetal heart tones. Ms. Diaz
subsequently delivered a stillborn male infant weighing

10 pounds, 4 ounces.

This tragic outcome could have likely been avoided if the patient

had been seen on the day her appointment was scheduled.
There was obviously no communication between the front desk

and the back office. Many physicians’ offices use the front desk
as a “gatekeeper” to address walk-ins, late arrivals, insurance

or payment issues, and other matters unrelated to medical
decision-making. However, the decision as to whether a patient

is to be seen should be made by a clinician. Moreover, the
purpose/urgency of this scheduled visit was not communicated

by the physician to the front desk (or the patient). This case is a
prime example of how a simple communication error unrelated

to medical judgment can create an indefensible claim.

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