Defendant Physician's Assistant's Videotaped Deposition
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- Опубликовано: 9 фев 2025
- This is the deposition of a physician assistant (PA) in a case that resulted in a $5.2 million verdict. The jury found liability for both the doctor and PA even though the lawyer for both implicitly argued at times that the real responsibility lied with the doctor.
Facts of the Case
The plaintiff is/was a really good guy. A married father of two adult children, he was working two full-time armed security officer jobs. He started working armed security at the Social Security Administration in 2003 and started working full time at CMS in 2005.
On the date of the incident, he was working at the Social Security Administration building. He was on his way to the parking lot when he was injured. The SSA has a gate that prevents people from driving into the SSA loading dock. The loading dock is equipped with a safety gate that can spring up out of the ground in order to prevent a vehicle from entering the loading dock.
As he was walking out of the loading dock, another employee activated the gate just as he was walking across the gate which was down. The metal gate sprung out of the ground, lifting him into the air and trapped him in the gate. This is a big, strong guy. His left leg was twisted and intertwined in the gate.
As he was trapped in the gate, someone from the SSA noticed him and came to his aid. Paramedics arrived on the scene at 1428 and told him, “Don’t look at your leg.” He was transported to St. Agnes Hospital by ambulance. The paramedics documented his history that he stepped over into a security gate, that his foot got stuck inside the gate, that his body twisted, and that all of his pain was in his left knee.
TREATMENT AT ST. AGNES
He arrived at St. Agnes Hospital by ambulance and was triaged at 3:22 p.m. The triage nurse noted that he sustained a leg trauma at work, she noted a deformity, that he was unable to move his left foot, pain scale 7/10, and positive for pedal pulses. He was sent to the Urgent Care part of the emergency room. An IV for Dilaudid was inserted at 3:25. X-rays were also ordered at 1525. The Dilaudid was delivered at 15:27. So there is a good start here. They moved quickly.
Dr. Jackson claims Krupa Shah, PA ordered the pain medication and Krupa Shah, PA claims Dr. Jackson ordered the pain medication. Based on the testimony of both of these Defendants, it is clear that neither Jackson nor Shah ever took a history from Mr. Tolson or examined him before the administration of the Dilaudid, or before the X-rays were ordered.
Krupa Shah, PA examined the plaintiff at 4:00 p.m. The history that was taken by her is somewhat strange. She thought that his knee was struck by an overhead door. Her notes indicate, “left leg caught up in a barrier door.” She did document numbness, paraesthesia, and sharp pain. One of the theories advanced by the defense is that the plaintiff did not provide an adequate history describing the mechanism of injury that would suggest a dislocated knee. However, regardless of the history provided, Dr. Krupa Shah suspected a dislocated knee.
All the experts agree that if you suspect a dislocated knee, you have to rule out an injury to the popliteal artery. She never performed any type of laxity exam on his knee before or after the X-rays were done. The chart would suggest that she never even reviewed the knee X-rays. She concedes that upon discharge, the only neurovascular assessment she did of his leg was to take the pulse in his foot. According to our vascular surgeon expert, his injury would have been apparent in the Emergency Room. If he was examined properly, the injury to his popliteal artery would have been discovered in the Emergency Room. He will also testify that if a vascular consult occurred on December 3, 2009, he would not have lost his leg.
Krupa Shah’s testimony is that the emergency room only evaluates for life or limb-threatening injuries and that orthopedic injuries can wait. But she failed to do the one thing she is there do to: save his limb. The medical literature suggests that 33% of all dislocated knees result in an injury to the popliteal artery. For a PA to suspect a dislocated knee and fail to rule out an injury to the popliteal artery amounts to a breach of the standard of care - slam dunk.
Our firm worked hard on this case to get the plaintiff the verdict he deserved. But the jury liked and respected him. That is a big deal. Even after losing his leg, he went back to work as an armed security office as quickly as he possibly could. He is not a malingerer and he is not a complainer. He works hard to overcome his disability and is hard-pressed to even describe how losing his leg impacts his daily life. He is glad he is alive, and he went through a lot with a smile.
You can find more sample depositions at www.millerandzo...
I have fallen in to the YT rabbit hole of medical depositions. As a retired RN I frequently hear someone yelling at the screen (it's me). The most frustrating detail I see over and over is the Medical Practitioner stating they don't read any of the "nursing pages, I just go see the pt". Nurses spend an enormous amount of time documenting and it's frustrating to see it only truly noticed during a trial. Accurate, complete, clear and concise charting is always right and expected. Many times RNs spend an hour after their shift, sometimes off the clock, completing charts they had no time to do during the shift. The pt's needs always come before the nurse's charting needs. The offhand dismissal of 'nurse papers' hurts.
Exactly what I spend hours after my shift documenting
RN here, well I stopped practicing, glad I got out , sad but true. Your comment resonates with me. After 12 hour night shifts spending the morning charting. 😑
The physicians should always speak with the nurse before going in and seeing the patient, or if not possible then, afterwards to ask them what they found. Maybe they don't read through the charting, but they should ALWAYS speak with the nurse at some point, preferably before, seeing the patient. If there is a discrepancy in the patient history, then you will know. If there is a discrepancy in the physical exam finding, then you will know.
@@derekgrubbs7639 No.The doctor should independently examine the patient. THEN look at the nurses information. The doctor needs to make a diagnosis based on their findings, and then refer to the nurses notes. This would prevent any bias.
@@marlenesmithies7234 Physicians do not have time to refer to nurses notes. It is called communication handoff and is standard everywhere that the physician interacts with the nurse before seeing the patient, or will at the very least look at the documentation sheet as to why the patient is there. If they can't communicate with the nurse before, that is fine, but at some point the physician needs to discuss patient care with the nurse. There are plenty of times that additional information is picked up where the nurse may not have been told by the patient but the patient told the physician, or vice versa. Discussion before seeing the patient is ideal if you are to discuss the patient with the nurse.
The whole problem with these providers is that they didn't adequately chart the care they provided. Not charting was there downfall. This has really opened my eyes about charting.
It’s also clear that that they also didn’t chart certain procedures, because they neglected to provide them.
Remember the old rule, if it's not documented, it never happened.
Simple notation in the discharge notes that it is important to follow up with an orthopedic surgeon within 48 hours would have helped loads . As well as a notation of pulses, color, temperature, ROM, and splint training at time of discharge .
@@OOceaneyess THIS is the main problem with these providers!!!
That’s was the issue. You got it! That’s is probably what lost them the entire lawsuit
So dude won over 5 million dollars.
I question why he left in the first place if he felt he didn’t get the treatment he needed and also why did he wait two or three days later……did he do something to injure the injury?.
An old medical school pearl of wisdom…”Never let the truth stand in the way of a good report”
BS. Which Old Medical School did you attend? I'm guessing the one that said: "Never let the truth stand in the way of a provocative RUclips comment". You don't know what you're talking about.
You are not even worth the time it took to type this, you are absolutely clueless. Why do you think the vast majority of malpractice claims are won by the physicians ? And yes, it is a behind the door saying.
@@armedprophet3321 Sure. Which old medical school is that? I didn't see an answer in your diatribe. There are lots of reasons that practitioners (not just physicians) win most malpractice claims. But you haven't named any.
Scarey.
@@Harleysport1999 Scary but true and happens everyday.
If you did not charted it, you did not "do it" nursing 101. Scary but true.
that's what I learned; "If it isn't charted it wasn't done."
That is basic Nursing and Medicine .CYA document document document .... probably some type of language barrier here also this guy needed to be questioned and ask exactly what had happened instead of just allowing patient to say a gate hit my knee leg ...
I agree, Document, Document, Document!
However, if you charted it, you DID it. Just clock in, chart everything, and clock out. Easiest job in the world. 😂🤣😂🍻
Hell im a cna nd its the same for us. In her supervisors deposition she was asked if she exacted this woman to chart his skin temp if she examined him n she said no she isnt concerned abt charts as long as the patient is taken care of. CRAZINESS
If you didn’t chart it u can’t prove it was done! 🤦🏼♀️
Ax Michelle, she can find it!
Plurpee hahaha!
@@plurpee. maybe she could refer to her photographs or maybe Shmeeda remembers.
@Chris P Bacon especially in nursing homes
False.
I’ve been listening to the other depositions in this case. I ascertain that no one clarified what kind of gate or door it was and how his leg was impacted. I realize that it’s an ER, but it seems that if they had known that, there may have been further studies done on the knee. Perhaps an immediate referral to an orthopedic doctor would have been wise. It’s better to over-treat than miss something so dangerous for the patient. I haven’t heard anything about whether anyone ascertained his pain level by documenting the pain scale within 15-30 minutes of the administration of analgesics, or upon discharge. Even though a nurse doesn’t order a discharge, he/she is responsible for knowing the patient condition, and can advise the doctor or PA if discharge is not wise. As a nurse, I have done so. In one instance, the doctor did not agree with me and completed the discharge. The patient died a couple of days later as a result of missed/ignored symptoms. I was not held liable because I carefully documented everything, including my conversation with the doctor re. my discomfort with discharging her.
Very true but nobody does from torn knee.
If it was a crush injury the first thing they would have checked for would be compartment syndrome, which is what it sounds like he may have had the beginning stages of.
Because all these emergency rooms think all ppl think that ppl are only there for pain meds, where over the year’s ppl have ruined that for ppl that are in a lot of pain and they leave u sitting there with a fractured bone with no meds even after X-ray/mri, etc…
@@terrybunsey8015 you may be right I haven't been to the ER in 20 years.
Let’s be really clear. The RN who performs triage is the first medical provider that has first contact with patient and including getting vitals and charting initial complaint, the nurse also observes the patient to determine the acuity of care that will start the patient’s visit to the ED. Patients may not always be good historians, but by observing the patient discomfort level, pain level to the chief complaint what they write in the triage notes is always important. As an ER PA, reading and comprehending what triage charts is vital to entering the room and beginning our initial evaluation of chief complaint, sign and symptoms patient presents with, the review of systems, past medical history, allergies, etc. In doing so, it is important for the medical provider to ascertain the patient’s presentation, complaints and fitting that into the examination and orders for tests as well as meds and way of transport, I.e. by IV or by mouth.
Discussing treatment protocol with the patient’s RN allows for dialogue, and understanding of how to proceed in evaluating, treating the patient needs.
Any provider who does not see the ER RN as a source of patient protocol, skills and clinical knowledge is not a very thorough provider. It is also important to discuss the patient with the RN assessment of patient needs and care. Many, many times the patient will relay different information whether a snippet or more complex info as they may feel better in disclosing to one medical staff than another. It is true and impirtant in understanding the team approach in providing care for our patients.
Thank you, thank you……for all you do, know and say!!!!
It’s astonishing to think of the number of supposed professionals who failed this poor man. Just a chain of incompetence
After to listen to almost all of the available dispositions of the involved parties and expert witnesses, I thoroughly disagree
It’s not always incompetence or blatant negligence…sometimes it’s a series of very unfortunate events. If you really think about it, there were no winners here.
The accident was unfortunate. The exam and treatment were beyond incompetent.
The only incompetence here is on the part of idiots like you and the plantiff. This is a frivolous lawsuit and is a great example as to why the health care system in the USA is as screwed up as it is.
This poor man seems to stumbled into a room full of incompetents on his worst day ever. Talk about wrong place, wrong time and wrong people.
Ouch. I'm not in the medical field, but I would think the 'chart' should be so detailed that any other doctor can come in and read the charts/documents and be able to take over from there without having to ask any questions. Right?
You are absolutely right. Thorough documentation is one of the first things taught in nursing school, so I'm sure it's stressed in medical school as well.
There are good and bad doctors all over the world, same with the PA community. I once had a VA doctor accuse me of faking heart problems 10 weeks after I had a heart attack and five bypasses...
Omg 😱 that’s terrible and I’m so sorry 😐😫☹️💟
I had a cardiologist tell me that “If all the fat women in (my town) complained about being tired, I would not get anything done.” Saw another doc, testing done, severely stenosed aortic valve, valve was replaced in short order. What a jerk.
True but no one whose education comes from another country...especially India in "Holistic" shaman medicine, should never be qualified to be a PA!
@@truthteller9071 I am sure she would’ve had to receive much more training and certification in the USA. You seem to be implying she went directly from holistic practice in India to a PA position in the states.
The VA is really bad at under examining soldiers. They are more worried about their license than they are helping the patient. I remember I had broke my thumb (Bennetts fracture). It’s actually a really severe break to a bone in my hand that made my thumb stay dislocated. They said I had a sprang and that I would be fine. I fought and pleated with them that something wasn’t right because my thumb kept dislocating. They would move it and put it in place and then when they let go it would go back out. So later that night I couldn’t bare the pain being they gave me nothing at the VA hospital. So I went to a hospital that had a hand and foot emergency room. So I went to them. The doctor looked at my thumb and told me what it was before doing any X-rays or scans. He told me it was a bennetts fracture and surgery is the only fix. But he did do a scan and it verified his educated opinion. Within three days I was having surgery at kuntz and klinert hands specialist. One of the best in the world. They were able to fix it with three pins holding the broken bone together so it can heal. I went back to the VA hospital after the surgery to see the doctor I saw the night it happened. I expressed to him what a piece of shit doctor he was and that I was going to sue his ass for medical malpractice. Which I did do. It didn’t even go to trial. We did deposition’s and that was as far as it got. He settled for an amount I can’t tell anyone. But it was enough to satisfy what happened to me. So I will never go to the VA for
Any medical appointments. I make them send me out to another hospital and the VA pay the bill. I’ve had a couple of surgery’s done outside of the VA.
It's amazing how non medical people's opinion of the MEDICAL case is based on:
1) how a person looks
2) how frustrated a person is
Beware the MOB
Agree the how a person looks is completely off base and not correlated to anything.
So true!!!!!
Yep! Especially a certain woman related to this case. Sheesh, its sad and kind of shows how our country is.
Sounds like the triage nurse is the only one who caught on to the seriousness of the patient's injury!
Which is quite interesting when you watch the triage nurse’s deposition. I suggest you watch that one next!
The pa and er doctor depositions should be played in medical school for all med students to see. C;early a failure in medical documentation.
This was a learning experience for medical history in all capacities . It should be reviewed in all medical schools as a “case study”.
Not sure if we agree on the definition of 'facts'. In the notes section right under 'Facts of the Case' you state "The plaintiff is/was a really good guy." That is an opinion, right?
If u go to an urgent care and see this PA and the attending physician Dr. Jackson....RUN
ESP dr Jackson. It falls on her . She can override anything she finds wrong with assessing or planning or evaluating or discharging…if u don’t want to die, just stay home😳
Love all the non-medical types Monday morning quarterbacking the various cases; these are the best part. Reminds me of the Facebook virology/immunology-educated folks.
i feel like the medical professionals see people in pain everyday to the fact that they get numb to it
Then they need to quit.
I feel the same. Doctors have gone numb if not dismissed to what the patient tells them, of the patient’s family on their behalf. We have experienced poor ER treatment ourselves and this videos justifies what we have experienced. Doctors protect each other with their contract with the hospital. The hospitals also use the ER as training ground, but less supervised by senior experienced doctors. Empathy has been removed from patient care.
This is the future of US medical care -- evaluation of medical problems by non-physicians.
@Concerned Citizen You sound like one of those people who'd literally prefer to die than to have one of these "damn foreigners" save your life. I'm not, by the way, referring to woman in the video.
Please refer to google and do yourself a favor. Research what is a physician assistant and which medical training they obtain, licenses and so on.
@Frank Stein Yes, it is here now.
@Concerned Citizen Such a hateful statement.... that also is not necessary or helpful and supports the divisiveness currently plaguing our country. "Be the Change You Want To See In The World", not the follower or the weak one.❤
@Concerned Citizen Unfortunately I'm not capable of " just sucking up hate". However based on your previous comment I can understand why you would send this respons. Oh Well ❤
I would feel ashamed to tell anyone I have a "license" in homeopathy and then have to explain what that actually means...
@Digitalbumpin LOL. Homeopathy.
"Does your homeopathy license allow you to prescribe medications?"
"Homeopathic medications, yes."
"Does that include narcotics?"
"Ha, no! All homeopathic medication is just magic water. If it has anything besides water that isn't diluted to the point where it literally isn't present, then we don't consider it medicine!"
chilldudemanguy what’s your job?
It is not well know in North America as it is known in India or Germany, I guess
@@lambadamarkasi Don't confuse traditional medicine with homepathy. The former has a long history and a slowly but steadily body of literature in qualified support of at least some aspects of it, the former is pure quackery.
When patients are dc’d from ED, they are given discharge instructions , which include what changes to look for, to warrant trip to MD, and follow up with your dr the next day. When did he see his MD? What changes took place and when did he seek MD care that ended in amputation.
He already had no blood flow in the leg at the ER but they didn’t do enough to check. That’s why his muscles died and he lost his leg
@@annab405 According to testimony he had 2+ pedal pulses present indicating blood flow at that time.
@@patsyadams734 I don’t believe it. All they had to do was to bring in a machine into his room and check the pulses in the whole leg or send him for MRI and find out what exactly is going on in the knee. From the beginning she thought he had more that he did. But she neglected that and that’s why she and the hospital are at fault!
@@annab405 3 providers independently charted +pedal pulses..doubtful all 3 can’t be believed, and the Doppler is only used when pedal pulses can not be found..other than that they aren’t useful..and if pedal pulses are present there is no need to check pulses proximal otherwise the pedal pulses wouldn’t be palpable
@@autumnanne54 I also said that they could have sent him for MRI since she thought there was more wrong with his leg from the beginning. As far as the notes go…very crappy for a hospital. The main nurse said in her deposition that she didn’t put his leg brace on and it must have been the doctor and this DR said it was the nurse and she doesn’t even know what kind of brace it was. It should all be in the notes!! Since they are hand written they can add anything! Either way I’m glad he won 5.2 million dollars!!
Pretty simple case.
Suspected a dislocated knee. 33 percent of dislocated knees cause an jnjury to the popliteal artery.
Even though she suspected a dislocated knee, she never once looked into a possible arterial issue.
It's her and the doctors fault. Period.
A basic Google search will tell you that this is the truth. It should have been at the top of their list of things to check for.
I find it, interesting, too that the patient was obese. Wouldn't that in itself increase the probability of increased severity of the injury?
Correct!!!!
Homeopathic medicine cured Steve Jobs....oh wait..
and bob marley too!!!!!!
Homeopathic are nature’s herbs! Not regulated by the FDA so results are not evidenced- based.
Im not against homeopathy but this woman was suppose to be practicing standard medicine. She prescribed 2 separate pain drugs. I dont know if she told him to go smoke a bowl when he got home or chant something 3 times...India's holistic medicine is pure witchcraft & a scam
@@adanacman666I'm related to Bob he's my 10th cousin😂
She is more personable than the cold, dismissive, arrogant and neglectful doctor.
My thoughts are the following (regarding the discussion starting around 36:40): the peripheral pulse assessment grading is on a scale 0-3+: 0 = no pulse, 1+ = weak, thready pulse, 2+ = normal, 3+ = full, firm pulse; if we use the peripheral pulse assessment pulse amplitude classification scale 0 - 4+, then 0 = no pulse, 1+ = diminished, 2+ = normal, 3+ = moderately increased, and 4+ = markedly increased. So, basically, 1+ means it is detectable, but diminished, and not what she said (that it is not detectable). And that was just one to mention (besides cold foot which "does not mean anything" , etc.).
dessertcat36 I was concerned about that as well. Based on her description, +1 as “non-detectable” would indicate a +0. +1 is weak, but palpable. She should have never used the term “normal” when describing +2 or +3. I think that she was trying to explain that his +2 in the affected as well as the unaffected extremity, so based on the pulse on the affected leg being indistinguishable from the unaffected leg, this was a negative exam. She also damaged her own testimony by starting the deposition by admitted that her only memory was that he was sitting in a room with a lady. She later substantiated the completeness of her exam by saying “I was constantly palpating”, since she obviously couldn’t rely on her own documentation. Personally, I don’t think that this guy’s exam or treatment was below the standard of care for any Fast Track in any ER based on his presentation, mechanism of injury, exam or diagnostic findings, but she let the attorney box her in without disputing the suggestion that any ER practitioner would have had a high suspicion for internal derangement based on the facts presented on this case. The ESRI is based on predicted resource needs, and I think that a 3 was probably unwarranted in this triage based on the fact that he only required an extremity film, pain meds and a splint. I would have made him a 4. That being said, I’ve sent priority 3 patients to Fast Track if I think they might need blood work and IV antibiotics as well as radiologic exams, but is otherwise stable.
dessertcat36 Gump you’re a freakin genius
I am sorry to say, but this PA was not well-prepared for the deposition. Starting at 1:15... she should have used the medical terminology and offer explanation. Basically, they discussed the Emergency Severity Index (ESI) (1-5). Besides they could have looked up the patient flow on that day to establish the need of changing ESI from 4 to 3.
BLOCK her addresses!
All the evidence was there of a more serious injury that resulted in decrease blood flow and nerve damage. A MRI should have been ordered to evaluate all structures of his leg.
He never should have been discharged until that was performed.
Agreed!
Right!!! And every patient who has a hurt leg should be admitted to the hospital for a week and seen by every specialist you can find and I’m sure the insurance company would be fine with paying for a head to toe MRI! MRIs aren’t an ER exam. That’s why the paperwork we hand you at discharge says your XRay was normal and you should call the phone number on the paperwork to follow up with the orthopedist.
@@JohnRundle09 An MRI takes less than an hour - nothing of the "week" is needed - quit exaggerating.
Document, Document, Document.
Sounds like Dr. Jackson was lazy and didn’t supervise this PA, with only a year of experience as she should have. From watching these sounds like the PA did as much as her experience allowed her and Dr. Jackson failed her and more importantly the patient. PA didn’t seem to try and cover anything up while doctor couldn’t answer a single question without sounding like a lawyer lol. In my opinion the PA did all the work and doctor never saw the patient nor supervised her her work AGAIN as she should have
The PA was SUPPOSED to do ALL of the work ( he was her patient). If the PA examined the patient and then the doctor examined the patient that would be a duplication of effort, and too expensive and needless to sustain. If she felt the patient needed additional assessment then she should have informed the doctor.
@@ek2137 I guess you haven’t watch the doctors disposition than. The DOCTOR SAID SHE ALSO EXAMINED THE PATIENT. The doctor is supposed to supervise the PA and see if everything had been done properly and Obviously didn’t!
Yet patients will tout how physician assistants and NPs are equal to or superior to doctors, and will vote on bills for for physician assistants and NPs to practice independently. Cant have it both ways, either the public thinks they’re as qualified or not.
@@moniqueharris5721 yet we also see here in this case an incompetent MD so dr are not always superior
I found the PA to give straightforward, reasonable answers. Patient still needed the follow-up detailed evaluation by the attending physician, who seems to have not not performed a thorough follow-up. Way too many racist and demeaning comments being made here about this PA, who actually conducted herself professionally in her deposition. Drove me mad hearing plaintiff's attorney keep incorrectly saying Physician's Assistant assessment, etc. It should be Physician Assistant's assessment, etc.
Agree Lanialost
Agree
Agreed
As a PA, this (and any) PA should be working together with all the docs present, but she has the scope and ability, and the duty, to do the same level of detailed assessment, testing, plan, and treatment that any physician would do. If a specialist is needed, that is a different story.
Well, most white people are racist, what more can you really expect from them?
Gross negligence to the max.
Even if it got worse over several days that ER doctor sunk the titanic.
Her head tilt and body language is hurting my neck just looking at her
Increased eye blinks, mouth tightening and cover with hand..
"I have a homeopathy license" = "I practice voodoo and I am a con artist."
ruclips.net/video/Cup6KR-o498/видео.html
😅😅
Exactly! India is a disgusting place & "Holistic" doctors there are about as credible as a witch doctor in Africa
Did this man also get compensation form his employer re the gate?
5.2 million dollars
I've stayed up all night watching three of these depositions. All three say they don't have to chart their own exam results. That's gross neglegance and not true. If you do it, you chart it. You never rely on another previous exam result or finding. Charting and documentation is as much nursing as is patient contact and treatment is. And you chart at the time, not days or hours later. These professionals seem to think they are above the whole scope of practice. I agree with the malpractice 💯 percent.
Standard of care in the ED is to chart by exception. That's what they meant.
All she had to say is that you document by exception. When she documented neurovascular was intact, that meant palpable pulse, warm extremity and range of motion. She didn’t explain this standard of care and practice of documentation of assessments well and it made her look like she didn’t really do it or that she should have documented the normal findings. That being said, when you have an injury to an extremity, it’s wise to reinforce warm, pulses palpable, wiggles toes, especially after the application of a splint, but in an urgent care setting with a high volume of patients on a typical afternoon, nurses and providers often document by exception...it was evaluated and findings are normal unless otherwise stated.
Exactly.
Being in a busy department isnt an excuse for not doing appropriate tests, is it?
A lot of focus on charting and charting by exception, (meaning you only chart positives and if not charted it’s normal) and that is the key to culpability. However, why does it matter bc clearly the leg was not okay and charting that it was okay wouldn’t have changed it. The injury was missed. Period. The problem here was that the guy got triaged to urgent care. My jaw dropped when I heard that. I was thinking with this mechanism of injury with an obvious deformity he was going to be a trauma patient. It’s crazy he went to urgent care.
this is a massacre. She missed the diagnosis. Just pay up.
Thank God she is not currently employed. According to her nothing in your examination matters once you determine you are ordering xrays so why bother.
Awful.
They ate NOT Physician’s Assistants; they are Physician Assistants
@Still Sidda what are you even talking about?
Yeah because they assistant physicians… 🤡
NO ONE THINK OF CLOT, EMBOLISM, after any injury to limbs.
As an ER PA you have to do complete patient assessment.
No $hit $herlock , “PA” you are a Doctor wanna be…. 😂🙌🏻 didn’t work out. Sit down wannabe
lmao this attorney does not play at all 🤣
The head of Vascular at John Hopkins who reviewed all the documents stated that they did everything right.
Interesting!
I wouldn't put much faith in anyone from John Hopkins. Look up Dr. Nikita A. Levy. That's the quality they've got working there lol not exactly the highest standards 😂
This man lost his leg and everyone involved in his care (after watching these depositions), doesn't seem to give a crap!
the whole medical field are filled with people like this. it's very rare you will find a doctor that wants to spend time with you as a patient and really cares. I have found a doctor like this. and I wont even giver her a good review online as I know I wont get any more appointments with her cause fully booked out lol
How about the idiot who put the gate down on the guy's leg? Where's that deposition?
We are all responsible for our own safety.
That’s not fair. I believe they did care and treated him
@@Packer1290 that has no bearing on this matter the case is about malpractice from the hospital not treating properly resulting in them amputating the poor guys leg. Whoever dropped the door on his leg or if it was his own incompetence like not following safety standards resulting in the accident that’s a different lawsuit with the work company or manufacturer
Question did anyone’s licenses get removed ?? What was the outcome for the the nurse, PA, and MD?
I hope so.
Now, having read the synopsis, I realize how inadequate my knowledge of ER requirements is.
He could move a little bit, so can a dying man
Wait didn’t the doctor say that the Physician assistant prescribed the pain meds?
Incompetent PA fluid in knee after an injury, OH it is nothing.
12:29 someone’s stomach growling into the mic lol. That’s a first 😆
It’s part of exam in deposition.
Recently I had dizziness, vertigo and fluids coming out of my nose when I leaned over. Uncomfortable dripping. I emailed my neurologist ( I deal with chronic migranes with aura) she sent me to the ER to get a catscan. The ER dr. told me in the 20yrs she's worked as an ER physician she has never seen anything major presented with symptoms but would go ahead and do the catscan per my neuro's recommendation.
My catscan came back normal minus a thick mucous wall. Ended up being an ear infection and nasal drainage. Her notes that were sent over to my neuro were pretty snarky, my neurologist kept apologizing to me for wasting my time. I told her, not at all THANK YOU! It could have saved my life had something serious been wrong. I was appreciative she cared and cautioned on the side of safety.
Last time an ER dr told me she hadn't seen something in 20 plus years working, I ended up developing a 4 month post partum infection and almost dying from sepsis.
We have 1 hospital/ED where I live and they chart exactly like this. They are vague, quick, presumptive and often have the worst bedside manner. They ask only basic questions & chart minimal info.
Not their problem, cross their fingers and document for YOU to fu with a physician or come back if your symptoms get worse. What does that mean to a man who already had pain, the slamming of the door had to cause swelling and numbness . He doesn’t know, I bet my leg , what is serious , what changes he needs to report back for STAT…so many people are just like him. They trust the hospital staff, most don’t know a CNA from a PA to a RN or MD.
They use education as a tool to get an honest career,but their honesty is invisible.
I bet insurance was a factor regarding the MRI, but it was work related they should have done an MRI. Hospitals are for profit...so everything is related to profit, care is secondary.
I doubt it. The providers and nurses get paid regardless of what the patient’s insurance does or does not cover. A ton of the patients that come to the ER don’t even have insurance and we still do a full work up.
The charting was sketchy, for sure. But they all got anchor bias from the triage nurse downgrading him and not considering the paramedics assessment and not getting a mechanism of injury. He got pushed through to the urgent care where the people that are triaged to you are supposed to be minor, the patient didn’t speak up and tell them what happened, the X-ray was beg and out he went. They all have liability, but if you wanted to look at it from a risk perspective, the main problem was in triage. I get everyone mentioning about if it wasn’t charted it wasn’t done, but in this case, the outcome speaks for itself. He got his leg cut off 2 days later.
Seems she is the only one here who cares. She is no longer working. Why not.
Who the hell is that coughing 😡
Someone with gastroesophageal reflux disease for sure ( GERD) 🤣🤣🤣.
😂
The ultimate decision to release pt. was the attending MD/ PA. Not the nurses. Reason: high risk Dx., elderly ( poor circulation already), the edema in conjunction w/ immobilized further compromised circular due to Pressure. Amputation due to poor circulation was eminent as his edema/pain/immobility = bad prognosis! 5million awarded! 80 y/n order are accidents in waiting. The PA dropped the ball! ( retired RN)
The PA & the physician!
The patient was 49 years old, not elderly, and it was a work related injury. (retired RN)
@@truthteller9071 and perhaps the nurse.
They really did this poor guy a injustice. Of care.
She was cruising the questions for a good 10 15 mins then totally just threw the case in the bag when she said she told him to move his own knee to see the range of motion.
Homeopathic physician... and I'm a teapot.
I think that it is convenient for both the PA and the doctor to remember quite well details when it favors them and not the other details!
I agree with the broad sense but specifically, I’m at a loss..😜
How can these videos be so important legally and be filmed only a decade ago yet the video looks like 90s vhs.
I am a retired physician when PA come to see me I tell them get me a real MD if no then I am holding the hospital or clinic responsible for anything happening to me.
I have CHD and get chest pains daily.
Feel terrible for the patient who lost his leg.
Yea but charting needs a knew way bc when charting is taking all your time away from the patient theirs a problem
For some reason this ER units policy was to chart by exception. This needs to be rectified by the hospital
@@marlenesmithies7234 you are so right!! The next time someone comes in for a cut on their hand I should definitely take 20 minutes to listen for a heart murmur and assess bowel sounds and chart it all and then walk out front to hear all the people whine about why they have to wait to be seen for their 4 months of foot pain.
@@JohnRundle09 that’s not the same thing at all. If someone comes in with a hand problem obviously it depends how they got that problem. If it was because of a fall and/or there was a reason to suspect other issues for example the elderly, then yes you would check everything. If it is a young person or child and there is is no reason to suspect abuse, then continue to just examine the hand and record the findings. It’s easy. It’s what we do in the UK.
@@marlenesmithies7234 my initial comment is in regards to a comment that said charting my exeption was bad. You seem to agree with me. If they are old and have an arrhythmia I’ll chart a cardiac assessment. If the are 22 and cutting a lime then I won’t. So what you are describing is charting by exception and I agree that it works.
@@JohnRundle09 In the UK we would chart what we found or didn’t. For example a young child with injury to their hand which could be due to child abuse, eg. A burn. We would state why, if we did not believe it was child abuse or why we did believe it was child abuse, stating our evidence. Otherwise you could end up in court years later, having to defend the fact that you did not safeguard that child.. It is difficult in a society where suing is the norm. You just have to cover your back from every angle. This case is a good example. In the UK we also always seem to be short of time but it has to be done.
I admit I wasn't going to watch these (alot of hours for a nitch area) but the comments from the hospital workers make these intriguing. One thing for sure I wouldn't ever want to work in a field were the smallest of a error can lead to death, give me the error of a steak taking to long as a server.
Other jobs to avoid; air traffic controller, airline pilot, EMS worker, police, fire fighter, crane operator ... Bless them all! I think medical and police jobs have greatest risk of lawsuits and police jobs biggest risk of prosecution; and both even if they do everything right! My mom worked for a hospital that was sued because the parents that allowed their small child to drown in their own pool during an adult party sued both EMS and hospital because they were unable to revive the child!
I’m a server and I freak out sometimes at work but I always tell myself “This is a dining room, not an Emergency room”
@@michaelhart7282 how funny. when I was an ER nurse, I sometimes called it glorified waitressing. we would have someone having a heart attack in one room and people yelling about a glass of water they didnt get in the next room.
Never forget a car is a deadly weapon, too.
That's why many of us have high anxiety & depression from the stress along with knowing what really goes on behind the scenes
THIS pa IS PROBABLY THE BEST PERSON IN ALL OF THIS. SHE LOOKED LIKE SHE DID HER JOB TO BEST OF HER ABILITY. EVERYONE ELSE was rude, arguing semantics , and the rest, I hope she found work again
I bet now the temperature of the limb is to be written down 5.2 million times
Lol.
Actually, you have to perform your job duties according to standards of practice for the facility, degree and place of employment (where it is in the country)
I don't think a really good guy is a legal fact...
Why did this man cross a known barrier that lifts from the ground at any given time that it's activated???
Ask him that when he grows a leg back.
Do you have any depositions which concern nursing home abuse? I'm far more interested in those, as so many people are being abused and mistreated in nursing homes. If you do, I'd like to see some.
I’d love that also!!
Ooh they do the elderly criminally wrong I'm sure y'all seen one or more videos of wrong doings to these people, when it seems like all they really care about is a paycheck!!!!! That's all in my opinion.....
This is one hospital I would never go to
She didn't know what the nurses assessment page was or reads it. !?!??
She shouldn't have taken the down fall.
No, she was an integral part of it.
my right arm has been hurting like hell since my heart catheterization. the pain is increasing. I have been on leave for this matter. I can't take leave for unlimited period. My family depends on my only source of income. I'm afraid to go to the hospital in a fear that they may do something wrong to cover up their mistake (intentional or unintentional). As I googled, I figured it's possibly damaged artery. Whenever I speak to the hospital stuffs on this matter, their tones sound fishy. They declined to set up an appointment. I'm a heart transplant patient. losing a limb can only make me a living dead. I don't know where to seek justice. Justice does not seem to be real in today's world. These doctors are paid 6-7 figures salary but look like they're paid to make people fool and take advantage of patients' bad luck. A doctor without ethical standard is a life destroyer. Unfortunately the system can't take that into consideration. The system is too blinded by networking, researching, and of course, the MONEY.
Go to a Doctor asap
These doctors aren’t making 200,000. Let alone a mil. She’s lucky if she makes 100.
If you are a heart transplant patient, you are followed by a cardiologist on a regular basis and you should have a PCP. You can go to them and let them know your complaints. They will evaluate and treat your problem.
Fucking lawyers. Yeah, let's wait until just before the statute of limitations goes into effect and ask people what they had for breakfast on a given day.
Dear lord! No wonder the patient lost his leg!! This lady didn’t do her job!!!! It’s not the nurses fault… They can only do so much. Orders come from doctors and their assistants
It looks to me like she had taken the fall for someone else. Her attorney did not prepare her adequately for the deposition.
The attending Dr signed off on everything and lied on record saying she repeated the physical exam
How he was hit ,caught whatever. They should have made sure there was no internal damage to the leg
I really don’t see how she was able to determine a popliteal injury period. X-rays were taken, there was physician oversight. I guess when in doubt send them to the hospital. This would have been difficult to do any better of a job than what was done.
All the experts agree that if you suspect a dislocated knee, you have to rule out an injury to the popliteal artery. She never performed any type of laxity exam on his knee before or after the X-rays were done. The chart would suggest that she never even reviewed the knee X-rays.
I believe the patient was already at the hospital. He was brought to the emergency room.
She worked in the ER...hence a hospital. She should have sent him to a neurosurgeon immediately.
@@truthteller9071
No this man needed a vascular surgeon.
Neurosurgeons work on the brain and spine.
She should have ordered MRI, or d admit the patient as a gate fell on his leg and could have injured nerves tendns especially if there was knee swelling and patient says numbness.
Crazy his award went from 5.2M to 1.5M
If it’s not documented it didn’t happen.
This is an emergency room not an orthopedic specialist group.
So what? Does that mean he shouldn't have received basic medical care? STFU tool.
AN emergency room physician and PA should be able to detect the severe injury that this patient had, including his vascular injury, The red flag is that the patient needed Dilauded to get his pain under control, that is NOT typical of a knee "sprain" as they dx him with, nor would a knee sprain cause difficulty moving his foot or numbness or tingling.
@@bettysmith4527 - I agree. Critical limb ischemia definitely caused intense pain. I am a Ph.D. Nurse Practitioner and I would have ordered a Doppler Ultrasound to assess the vascular integrity. Blunt trauma to the knee means a high probability of ligamentous damage as well as popliteal artery injury with thrombus formation 30% to 60% of the time in injuries like this one. The critical limb ischemia led to amputation in a 49 year old man. I always say "if in doubt, check it out". The whole incident is just awful!
ERs often have on call specialists, ranging from orthopedists, OB/GYNs, cardiologists, ENTs, etc. If you have a serious joint injury that requires immediate care beyond what Urgent Care can handle any ER should be able to treat you.
My friend even saw a trauma ENT at the ER when he shattered his jaw 👍 The staff working any ER should be able to handle any injuries that come in, including joint, neck, back etc. A cardiologist was even waiting for my neighbor when he was brought in for a stroke.
But an ER doctor should be able to assess and treat any serious joint injuries that come into the ER.
She didn’t even grasp his mechanism of injury
She looks like she could take a nap.
She’s a licensed physician who past state boards in the state of Maryland. She has done an excellent job of answering all questions. There is oversight of a physician who works with this patient. Very good job.
passed
She is a physician assistant, not a physician.
pretty smart to trap and discredit her so early in the depo with the homeopathy bit, knowing its tongue in cheek perception
A physicians assistant is not paid well enough for her acceptance of this level of scrutiny. Nothing near the equivalent of responsibility.
PA get 90000$ minimum.
lawyers trying to get a deponent to say what they want to hear rather than the truth and the normal accepted medical practices. The lawyer knows exactly that she will not be able to describe in detail how the doctor examined leg, what part she touched, in which direction, etc. that doesn't mean she didn't witness the doctor examining the patient's leg. very disingenuous.
Exactly!
FYI, there is no 's after "physician" in the PA title.
Oh no Homeopathic Dr . Who gives her certificate here in USA.
You "quickly" go over cardiovascular?
What a disgrace
Please get her professional correct! She is not an assistant of a physician…it is PHYSICIAN Assistant……❤
This is why the nation board of PA❤ has changed title to PHYSICIAN ASSOCIATE. We work with the ability for supervision from a physician not under physician supervision. We have 2 yrs +3 month of intense clinical medicine specialties as well as gross anatomy, physiology, pharmacology, pathology, statistics. Med student have 4 years but not in class summers and have several breaks through school year.
Pas have only 1 week off in 28 months. We do about 85% similar to med students plus we must have over 2500 hours in profession with patient contact.
refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
Guilty
Could she be any more vague? Pulse ratings in foot are 0-1-2-3-4 And she claims 2+ is the same as 3+ and both would be normal pulse 😒So what’s 4 ? Extra-normal? Super strong? He complained of numbness & tingling but that’s also normal after injuries 😳
Bounding
Having listen to the Dr and this PA...they don't match at all I don't think the Dr looked at the report or did an exam...she signed off and when on.
I don’t know about this PA, doesn’t chart, doesn’t think it’s severe and many others points
Its some scary stuff to know this kind of person could have my life in her hands.
I respect medical professionals tremendously. I think they deserve more than they make in most cases. Does she look “dismissive” to you?
I don’t think so.
This is a legal proceeding, it's all about having your poker face on!
@@bettysmith4527 exactly, yet the black doctor was called dismissive. No, she just had a poker face.
Not at all.
This woman shouldn’t be practicing!!
As a PA for 27 years I'd say this deposition DOES NOT support your conclusion.