I spent some time in medical school and as a hospital administrator before going to law school and becoming a Houston, Texas medical malpractice attorney. One of the very first concepts that I remember learning in medical school is the importance of a differential diagnosis.
Differential diagnosis is an intensive thought process where the doctor considers the patient as an individual and lists every potential diagnosis that could explain the patient’s condition or problems. Then, one at a time, starting with the most life-threatening or dangerous potential diagnosis on the list, the physician orders tests or conducts further evaluation to rule each one in or out.
These days, it seems like the differential diagnosis is becoming a lost art. Busy healthcare providers sometimes give in to the temptation of settling on the most common condition that could explain a patient’s complaints. When this happens, though, doctors are ignoring what they were taught in their first year of medical school and putting their patients at risk.
That’s exactly what happened in a case that I’m investigating now. A dad took his young daughter to a hospital emergency room in the Waco area because she started having a bad headache and associated vomiting the night before. He explained to the emergency physician that she had had on and off headaches over the last month.
The emergency physician diagnosed her with headache and vomiting. I find that incredibly bizarre, considering that the father already knew that his daughter had a headache and was vomiting, and that was the reason he brought her to the emergency room. Before settling on this benign diagnosis, the doctor didn’t order any diagnostic radiology scans of the head, like a CT scan or MRI. Instead, the doctor picked the most common and simplest diagnosis and sent the girl home.
Sadly, that diagnosis was wrong. Three days later, the girl returned to the emergency room with the same headache and vomiting. This time, she also complained of sensitivity to light and loud noises. The emergency provider ordered a CT scan of the head. The radiologist interpreted it as showing a critical finding of what appeared to be a mass near the brainstem and pons and recommended an MRI. A brain MRI showed that this little girl had hydrocephalus (a fluid accumulation in the brain) that was concerning for aqueductal stenosis.
One of the significant risks of hydrocephalus, like that of any other space-occupying lesion of the brain, is that there is limited space in the cranial cavity. If fluid continues to build up without properly draining, the brain can herniate out the back of the skull, causing a profound brain injury or even death.
In this case, the girl suffered apparent herniation before she could get the appropriate medical or surgical treatment. She’s now struggling to recover from her permanent brain injury as a result of all this.
As part of our careful workup of this potential case, Painter Law Firm will hire top medical experts to review the medical records and radiology images. I’ve handled cases very similar to this before and expect that the experts will be critical of the fact that the emergency providers on the first ER visit didn’t follow the differential diagnosis process.
Under the standard of care, when a patient presents to an ER with complaints of headache and vomiting, the physician is required to order diagnostic radiology imaging of the head, which would be a CT scan or MRI scan. I expect that the medical experts will determine that if the emergency room staff had followed the appropriate patient safety rules, this girl’s condition would have been correctly diagnosed days earlier, leading to timely treatment that would’ve prevented herniation and her permanent brain injury.
While all of this seems to be pretty straightforward, Texas laws are unfriendly to patients who receive care in a hospital emergency room setting. Under tort reform laws, medical malpractice plaintiffs must meet a higher burden of proof, called willful and wanton negligence, on these types of cases.
To determine whether the facts of a particular patient’s poor emergency room care could meet the willful and wanton negligence standard requires very careful study of the medical records in consultation with experts. This is exactly the type of complex work that we do at Painter Law Firm.
If you or someone you care for has been seriously injured because of poor emergency room or hospital care, I urge you to contact a top-rated Houston, Texas medical malpractice attorney immediately.