The medical professional discharged a patient with abdominal discomfort later revealed to be appendicitis
In a recent medical negligence lawsuit, the Supreme Court of British Columbia found that an emergency room physician met the standard of care in diagnosing and discharging a patient with abdominal pain later revealed to be appendicitis.
The case involved allegations that the physician's actions delayed the diagnosis of the patient’s appendicitis, leading to surgery days later.
The patient, who had a history of endometriosis, visited the emergency department at Kelowna General Hospital on November 30, 2016, with severe abdominal pain. The attending physician, an experienced emergency doctor, conducted an assessment, ordered an ultrasound, and included appendicitis and a ruptured ovarian cyst in the differential diagnosis. The ultrasound showed a normal appendix and free fluid in the pelvis, which was attributed to a likely ruptured ovarian cyst. The patient was discharged with pain medication and instructed to follow up if symptoms worsened.
Four days later, the patient returned to the hospital by ambulance and was diagnosed with appendicitis, requiring surgery. She subsequently filed a lawsuit alleging the physician failed to meet the standard of care by inadequately assessing her condition, failing to conduct further tests such as a CT scan, and providing insufficient discharge instructions.
The Supreme Court examined detailed testimony from the patient, her family, nurses, and medical experts. While the patient described a lack of communication and care, the physician testified that his actions aligned with standard emergency room practices, including reviewing the ultrasound results and consulting a radiologist.
Expert witnesses presented conflicting views on whether the physician’s assessment and discharge instructions met the standard of care. The patient’s experts argued that additional tests and monitoring were necessary, while the physician’s experts maintained that his reliance on the ultrasound findings and subsequent actions were reasonable.
The court analyzed whether the physician had followed accepted practices in emergency medicine, emphasizing that the standard of care does not require perfection, but reasonable judgment based on available information. The court concluded that the physician appropriately considered appendicitis in the differential diagnosis, relied on a normal appendix visualized in the ultrasound, and provided reasonable discharge instructions.
The court also acknowledged the complexities of diagnosing appendicitis, particularly in its early stages when symptoms are vague. The court noted that a misdiagnosis does not necessarily imply negligence if the physician exercised sound clinical judgment. In dismissing the claim, the court expressed sympathy for the patient’s suffering but found no evidence that the physician's actions fell below the required standard of care.
