Chapter 14 : The Nonphysician in Medical Malpractice Litigation

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Nonphysician experts will always be challenged as to their ability to define the standard of care. The expert may testify on a scientific or medical principle without offering an opinion on standards of care. In a particular case, a twenty-six-year-old woman became quadriplegic, because the woman did not receive antibiotic treatment for nine and one-half hours after presenting at the local emergency room. There is a high probability that the organism responsible for the plaintiff’s disease was (pneumococcus). Factors that influence the delay in the administration of appropriate antibiotics from the time of the arrival of a patient in the emergency department, include the age of the patient (children usually received antibiotics in two to three hours), how ''sick'' the patient is, and procedures performed such as CT scans. It appears that the impact of antibiotic delay depends to a great extent on the clinical state of the patient. In patients with fulminant (rapidly progressive) meningitis, such as sometimes seen in meningococcal meningitis, the duration of symptoms is brief, and a delay in therapy rarely affects the outcome; almost all these patients will die. In patients who present with generalized, nonspecific symptoms (fever, malaise, irritability, vomiting) a short delay of less than three to five days does not appear to alter the risk of sequelae or death. However, in patients like the plaintiff, with clinically apparent meningitis (fever, stiff neck, headache, lethargy, vomiting), an inappropriate delay in commencing therapy incrementally increases the risk of permanent injury.

Citation: Ellner P. 2006. The Nonphysician in Medical Malpractice Litigation, p 67-81. In The Biomedical Scientist as Expert Witness. ASM Press, Washington, DC. doi: 10.1128/9781555816520.ch14
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1. Durand ML, et al. 1993. Acute bacterial meningitis in adults. A review of 493 episodes. N. Engl. J. Med. 328: 21 28.
2. Radetsky M 1992. Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr. Infect. Dis. J. 11: 698 670.
3. Aronin SL,, Peduzzi P,, Quagliarello VJ 1998. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann. Intern. Med. 129: 862 869.
1. Swartz MN, 1995. Cellutis and subcutaneous tissue infections. in GL Mandell,, JE Bennett,, and R Dolin (ed.), Mandell, Douglas and Bennett's Principles and Practice of Infectious Disease, 4th ed. Churchill Livingston, New York, N.Y.

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