Page 23 - Hospitalists - Risks When You're the Doctor in the House (Part One)
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SVMIC Hospitalists - Risks When You’re the Doctor in the House
On July 20th, nursing notes indicate that Mr. Jones had
hyperreflexia. This finding did not concern Dr. Murphy
because Mr. Jones’ chronic conditions (diabetes,
etc.) often resulted in neuropathy. As such, he did not
believe the hyperreflexia was associated with an acute
neurologic event. The nursing notes also indicated loss
of vertebral body height, which Dr. Murphy attributed
to osteoporosis. Additionally, Dr. Carter had previously
noted that the t‐spine fracture would heal “because it was
inherently stable”. Accordingly, Dr. Murphy assumed that
Mr. Jones’ condition was stable. Dr. Murphy performed
no neurologic exam himself on July 20th. On July 21st,
Dr. Murphy likewise performed no neurologic exam. Mr.
Jones reported that his pain felt better.
Dr. Murphy saw Mr. Jones again on July 23rd, but, again,
performed no neurologic exam. Mr. Jones was not moving
much, which Dr. Murphy attributed to his level of pain.
From July 23-25, the nursing notes indicated that Mr.
Jones had generalized weakness and numbness in both
feet and that the neurological assessment was not within
normal parameters. Dr. Murphy again testified that he did
not normally review nursing notes and that he did not do
a neurological exam.
On July 26th, Mr. Jones was still complaining of pain
which Dr. Murphy attributed to the thoracic spine fracture.
His notes reflect an order to set up an appointment with
pain management. His orders further stated, “Discharge
planning”. Dr. Murphy explained that he anticipated a
discharge within one to two days.
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