The Emergency Medicine Resident – Avoidable Medical Malpractice Case


Dr. Theodore Watkins was a 31-year-old resident
physician from Roswell, New Mexico. He regularly went to the gym, ate a plant-based diet, and
practiced meditation – in many ways he was the picture of healthy living. Theo, as his
friends and family called him, lived in a 2 bedroom apartment with his girlfriend and
their dog Misty. One night, while he was playing with his dog, his alarm rang – he had a night
shift in the Emergency Room. He scratched Misty’s belly “Time to go! See you in the
morning!” The night shift was fairly routine – some
laceration repairs, a gunshot wound, a woman with severe panic attacks, and a mix of other
complaints. The clock in the emergency department showed 5:39am when a nurse announced that
there was a 43-year old male with a sudden onset of chest pain being carted in. Dr. Watkins
quickly drank up the rest of the coffee and replied: “Bring him in.” A few moments
later, a man was wheeled in on a gurney. He was breathing heavily, holding his chest,
and turning and twisting in pain. Dr. Watkins asked the man some questions as the team begin
to set up monitors, get IV access, and give pain medication. Through gasps – the patient
explained the pain started abruptly when he got out of the bed, and that he felt it everywhere
including in his back. Within moments information was flowing in.
The blood pressure in one arm was lower compared to the other one, the ECG was normal, and
the lab work had been sent off. The nursing team had also paged the overnight attending
physician, Dr. Chapman, and when he called back – the phone was handed to Dr. Watkins. “Dr. Chapman on the phone,” said the sleepy
voice from the other side. During the next few minutes, Dr. Watkins explained that they
have a 43-year-old patient with unusual chest and back pain over the last couple hours,
and that there was an irregularity in the inter-arm blood pressures. He mentioned that
the ECG showed no signs of a STEMI. Dr. Chapman seemed a bit more awake and spoke with intensity.
“Alright, listen up kid. Give him aspirin, clopidogrel, and enoxaparin. I’ve seen plenty
of cases like this. He has an NSTEMI and I’ll see him in the morning. You got it?” Dr.
Watkins was shocked, because Dr. Chapman seemed so certain. Nevertheless he managed to blurt
out some questions, “Are you sure we shouldn’t consult a vascular surgeon or perhaps get
some imaging study?” Dr. Chapman angrily responded, “I know what I’m doing and
I know my job. Do you know yours?” The call ended on that note, and Dr. Watkins hung up
and did what the attending physician told him to do. Over the next few hours, the patient’s condition
steadily worsened, but Dr. Watkins wasn’t willing to get yelled at again so he stuck
to the plan they had put in place. He also hoped that Dr. Chapman would come in soon
so that he could take over. Unfortunately, the patient’s condition worsened and a code
blue was called. The patient died in the emergency room that morning from internal bleeding due
to an aortic dissection. A few weeks later, Dr. Watkins received a
letter stating that his hospital was being sued and that he was being named specifically
because he didn’t follow hospital protocols that may have saved the patient’s life.
The letter specified that he should have consulted a vascular surgeon and obtained imaging more
quickly. Dr. Watkins said that he specifically followed the directions he got from his attending
physician. But the attending physician Dr. Chapman said that Dr. Watkins didn’t explain
the severity of the patient’s condition and that he wasn’t kept informed about what
was happening in the emergency room. Now – to rewind this back – let’s imagine
that Dr. Watkins had asked Dr. Chapman to document his plan and had also documented
his concerns about it. In addition, let’s imagine that Dr. Watkins had continued to
call back and give regular updates with changes in the patient’s clinical condition. It’s
possible that Dr. Chapman would have agreed to change the plan or that Dr. Watkins could
have convinced him to come into the hospital to see the patient. It’s very possible that
the patient would have been correctly diagnosed and treated sooner and that he wouldn’t
have died. The moral: Document conversations about critical decisions, and keep lines of
communication open.

32 Replies to “The Emergency Medicine Resident – Avoidable Medical Malpractice Case”

  1. What an idiot. I knew this before it was even mentioned though I would have done a Cxr and or chest CT regardless. And isn't differing bp's a hallmark of potential aneurysm?

  2. Watkins should have ordered CT angiogram immediately with those symptoms and after CTA call Thoracic Surgeon. Wasted time calling his attending with incomplete information about case and did not updated him if worsening symptoms. Needs to be fired from any ER program.

  3. People here are really hasty to judge. As a resident my self I can understand the avoidance of conflicts. Though sometimes you must follow yourself. The resident knew what should've been done.

  4. I have heard and even seen similar situations happened in my hospital.
    Never overtrust your seniors, if you are feeling that something is wrong, go after it. No one is a perfect physician.
    And most importantly DOCUMENT EVERY SINGLE THING!! You won't believe how fast your seniors can shamelessly lie aginst you in front of the judge.

  5. am interested an article of Dr Theo cases too see if its a true life situation as I think no normal resident at any level would respond the way he responded.. Hence my interest..

  6. As a resident, I couldn’t agree more to be persistent with your seniors and to do away with fear of your seniors. This was something that took me a long time to overcome.

  7. This scenario is very similar to how a lot of planes crashed before the 1980s, when the concept of Crew Resource Management was implemented at airlines. Emergency medicine could probably stand to adopt some of the same principles from CRM in the decision-making process.

  8. then way i saw it, dr Watkins fear of getting yelled at was at fault here. he should've gulp down his fear and spit facts to his attending physician.

  9. Dr. Watkins suspected a bad situation here obviously but he tried to avoid responsibility by doing only what his senior said. Come on, couldn’t he even search google for irregular bp in the extremities?

  10. Is normal to have a gunshot wound as a routine in emergency?or is it in US only?And Dr.Watson cant ask for a chest imaging himself?

  11. Also this as well as many surgery cases is the toxic micro aggression we need to remove from medicine. He did not want to get yelled at. The negative feedback seen in so much of medicine only damage team work and communication.

  12. I would have told him to watch his tone and catch me outside if he thinks he is hard like that. Lol. On a more serious note, sometimes you do have to stand up for yourself and call attendings out when they are condescending like that. They are not used to getting talked to in that way and usually ease up a bit.

  13. Ok, I am just a med student but aren't residents allowed to put in their own orders? I would have at least gotten out the ultrasound to look for dissections that way. EM people use ultrasound all the time.

  14. It's hard to overestimate an importance of these "avoidavle medical malpractice case" videos. We learn a lot of "pure" medicine in medical school, but don't know much about something behind diagnostic and treatment plan after graduation. Thank you so much! I would like to watch more and more videos like this one.

  15. I immediately thought of aortic dissection after that BP differential..
    I’ve seen attending physician scolding and yelling at resident in a hallway…rude and unprofessional..
    Another moral of this story: always ask or search up when unsure of something…these doctors sometimes are too confident…

  16. Just because you get advice from a senior doesn’t make the best advice. They don’t see your patient and are getting a handover the phone. Always use your own clinical judgement if you think the advice isn’t in the patients best interest.

  17. yep. resident screwed up. if its walks like AD, talks like AD and presents itself as a classical textbook case of AD, you get a GD x-ray and you call vascular surgery. If he knew something was wrong but decided to do what his attending ordered anyway for fear of getting reprimanded he acted selfishly.
    he's already a resident, a licensed physician, not a first year medical student.
    he should have had better judgement.
    throw the book at him, I say.

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