Falls, Medical Liability, and My Mom

My 90-year-old mom had another fall on Sunday afternoon. She has had A-fib and heart failure for more than a decade, and her cardiologist struggles to control that without causing her dizziness and low blood pressure. Which results in falls. After enjoying a warm spring afternoon on the patio, she lost her footing on the porch steps and fell backward onto the car and hit her head. Fortunately, she had her cordless phone with her, so she called me to come over and help her up. Her neck hurt badly, so I helped her gently into the car and took her to the ER. And there fear of lawsuits started driving medical decisions.

When we arrived at the excellent rural ER in Marion, Kansas, the nurses immediately immobilized her neck in the car and put her on a stretcher. I think they already suspected the problem. They called their radiology tech in from her Sunday afternoon, and she did a CT scan. As I later learned, the radiology tech immediately spotted a dangerous, potentially fatal, fracture in the C2 vertebra in her neck and pointed it out to the PA in charge of the ER. I could tell they were more concerned than usual about my mom, but I didn't know why. Following procedure, the PA e-mailed the scan to some M.D. somewhere to interpret it. An hour later the interpretation came back, "All OK." At that point the PA told me what was going on. She made a very polite call to the faraway M.D. and asked if he had seen the fracture. He was appalled at what he had missed and sheepishly corrected the interpretation.

Why couldn't they trust the radiology tech's immediate detection of the fracture? Why did they have to contract with some faraway M.D. to look at it? I'm sure he had an Official Certification in Interpreting CT Scans, while the local tech did not. If they trusted an uncertified local tech and she was wrong, they could be sued. But the tech was focusing on the one scan she did that day. She had personally wheeled my mom's gurney into the CT room. She had an incentive to look carefully at the scan. I'm sure the M.D. had lots of training and had seen thousands and thousands of scans. But he didn't know my mom. He probably had a stream of scans coming at him to be interpreted quickly for maximum profit. It was evening, so he was probably coming to the end of a long weekend shift. But his Official Certification would be a bullet-proof defense in a liability lawsuit.

But the protocol demanded another step that I think was only for liability defense. The ER called an ambulance, and they gingerly transported her 50 miles to the trauma unit at a regional hospital in Wichita. The trauma team did more scans and evaluations, all while my mom has endured 12 hours of IVs, blood draws, no food or water in case they needed to operate, beeping machines, and on and on. By today, Monday afternoon, she looks much worse than she did when she left the rural ER Sunday evening.

The trauma team decided it was too risky to operate due to her age and heart condition, a conclusion I wholeheartedly support. They decided to send her home (or to rehab, that hasn't been decided yet) with a collar and strict prohibitions on what she could not do. But why couldn't the local ER have made that decision, perhaps in consultation with her cardiologist? They should have told me to take her home Sunday evening with the collar in place. It would have avoided all the expense and the draining stay in the Wichita ICU. And we would have wound up in the same place.

Fortunately, Mom is a strong, plucky woman, so I think she will make it through this. But it's been a lot for her to go through. And it's cost the taxpayers and her supplemental insurer a lot of money. All to avoid exposing themselves to medical liability.