Thursday, April 21, 2005

Human interest notes--medical malpractice and the law

Yesterday I was reading a thing where Republicans were still blaming rising medical costs on medical malpractice lawsuits. I went searching through my files and found this story I wrote up from notes at the time, several years ago. I have changed the names of everyone but my wife, but it is a true story otherwise--as true as I can make it, anyhow.

It was a Saturday and I was supposed to be watching the kids. I glanced out of the window of my house and saw two 12 year old girls, neighborhood kids, sitting on a table in the yard. They were arguing. The bigger girl, Marilyn, gave a vigorous push that propelled Liz, the smaller girl, right off the table. Liz's arms flew out as she went off the table and she landed hard. She got up and ran home crying and holding her arm. Her wrist was broken.
When I told Barbara, the mother of the injured girl, what had happened, she said Liz was always provoking people to hit her. “She’s just like me. I was that way when I was a kid,” Barbara said.
It was a month or so later that Liz came over one day, anxious. “My mom's sick. I’m kind of worried. I think she's real sick...” She trailed off and got silent. We stood around in the middle of an unfinished appeal for help, until my wife Kay said “OK, Liz, let's go see about her.” We drove Liz back to the small apartment she and her mother shared a few blocks away from where we lived.
Barbara was making groaning noises in the bedroom. We went in and she was curled up in her bed, very pale.
“Oh shit I feel terrible,” she said. “My stomach really hurts.”
Barbara said the pain started right after she had a cup of coffee with a woman who had been a partner in her cleaning business. The two had not been on good terms, but the woman had invited her over for coffee saying she wished to put and end to the ill will between them.
Liz had told us beforehand, as we drove over, that her mother believed the woman had put cyanide in the coffee.
“Barbara, do you think the coffee was poisoned?”
“Poisoned? Well, God, uh, I don't know.”
Barbara was acting as if this were a surprising new idea.
“Well, you know, she was very, very friendly. It wasn’t like her. She hasn't been friendly before, and it sounds silly, I know, but the coffee tasted like almonds. I've read in detective novels that cyanide tastes like almonds. I got sick right after I drank it.”
Barbara was obviously in pain and asked us to take her to the doctor. “My stomach really hurts bad” she said.
I was alarmed. She was doubled up, moaning. She had been vomiting. Kay and I helped her out to the car and we took her to a minor emergency clinic. I don't know why. I guess because we didn't want to think that it might be a major emergency.
We spent a few minutes sitting in hard chairs in the waiting room. Barbara sat hunched over, groaning. She was not talking when we got to see a doctor. In the examining room Liz blurted out to the doctor “My mom's been poisoned!”
“Poisoned? What do you mean, ‘poisoned?’ With what?”
“Well,” I said, “she thinks it may have been cyanide.”
The minor emergency doctor recoiled at this information. You would have thought that I had just told him that the IRS was auditing his books.
“This woman doesn’t belong here,” he said to me.
Everybody was talking as if Barbara was not part of the conversation.
“Any poisoning, any possible poisoning belongs in an emergency room. If it’s really cyanide she could be dead in 15 minutes. I can call an ambulance, or you can take her to South Austin Hospital.”
South Austin Hospital was right down the street and had an emergency room. “I’ll let them know you're coming.”
He turned on his heel and left his examining room. Clearly he did not want the 15 minutes to expire on his premises.
Once again we helped Barbara to the car, and when we drove up to the emergency room there was a nurse waiting with a wheel chair.
They wheeled her into the emergency room. We heard more groans, punctuated now by an occasional scream.
After a couple of minutes a doctor came out, a young man with a perfunctory bedside manner that lapsed easily into rudeness. He kept glancing at his watch as he talked to me.
“Um, do you know anything that you could tell me about, uh, Barbara's problem? She doesn’t seem to be communicating.”
Loud cries from the examining room.
“She won’t talk about it, and doesn’t want to say what's bothering her. Pain sometimes makes patients a little...uncooperative.”
We recounted the events that had led us to his emergency room.
“Cyanide?” he said, incredulously. “Nah. Not a chance.” He thought a minute, as if to be sure what he had just said was true. “No... it’s not right for that. Whatever her problem is it’s not cyanide.”
“But we’ll certainly find out what it is” he promised, his voice recovering its smooth reassuring baritone.
He came back in five or ten minutes. Once again he had forgotten his bedside manner.
“There’s no way in hell she’s been poisoned.” He sounded exasperated. “Do you think any of you can help, maybe, to get her to cooperate a little? I can’t take her damn temperature. Can’t get her to say a word. All she does is moan.” Actually, she had stopped moaning. She would be silent for a couple of minutes and then she would scream. The doctor’s face got a little tense each time she screamed.
“You know,” he said to me in a confidential tone, “I’m not really sure this problem is physical. I'm still waiting for the lab results, but you know, I just suspect that this is, uh, a psychogenic ailment. The business about cyanide is not, y’know, what people normally come in with.”
He called Liz over, and asked her “Has your mother ever had this before?”
Liz said “Uh, well, I don't know. She sometimes has cramps.”
“How bad are the cramps? Does she ever cry out in pain?”
“Well, yeah, I guess, she sometimes does, you know...cry, and kind of, well, I dunno, make noises and stuff.”
The doctor returned to his examining table, this time with Kay, who was to try to help “communicate” with Barbara. Barbara apparently wasn't having any part of it. She wouldn't say a word. Kay came out in a few minutes. The doctor didn't come back for half an hour. Moans. Groans and shrieks.
When the doctor reappeared he wanted to know if Barbara had any relatives, who might be able to provide a background on any history of mental illness. Liz said Barbara had a sister in Phoenix. We called Phoenix information and got the sister's number. I phoned her and told her what was going on, and asked if Barbara had ever had any problem like this before. The sister was pretty brisk.
“Look,” she said, “Barbara is real flaky. She's always having problems. And I don’t want her problems to be my problems.”
Then she hung up. I relayed this news to the doctor.
The doctor said the tests indicated a slightly elevated white blood cell count, but nothing serious. Nothing physically wrong with Barbara could be found, he told us. He was going to give her a tranquilizer and a painkiller, and send her home. She had quieted down a little.
They brought Barbara out in a wheelchair. She looked terrible. She began to moan as we were arranging her departure, and fell out of the wheel chair onto the floor and curled up in a ball and began to make little short, sharp yips.
“Don’t send me home,” she said, her first words since we brought her in. “I’m sick.”
The doctor reappeared, annoyed, looking at his watch. He had told us he needed to be somewhere when his shift was over. He began saying soothing things to Barbara, to get her back in the wheel chair. Just then a sort of aggressively confident little guy came striding in and barked “What the hell’s going on here?” It was shift change time. This was the new on-duty physician.
Our man who was trying to soothe his patient back into the wheel chair was suddenly defensive. This looked bad, a woman being sent away from the hospital while curled up on the floor complaining of abdominal pain. He took the new doctor aside and they had a pretty vehement discussion, which I overheard parts of because it was kind of a shouting match.
“This is definitely, definitely, not a surgical abdomen, and I am getting her the hell out of here,” our man said. He was showing the new guy the lab results. They were gesturing and pointing at the chart. Finally the new guy said he was washing his hands of the whole thing, and strode out of sight to change into his emergency room clothes.
Our man came back and told us that he thought Barbara should have a psychiatric evaluation.
Barbara meanwhile was still in a fetal position on the floor in front of the receptionist's counter and would occasionally writhe convulsively making a noise like someone was jabbing her in the abdomen with a stick.
“You're not a patient here anymore, Barbara.” the doctor said to her. “You need to get up and go with your friends.”
He walked out into the parking lot, got in his Volvo, and left. We hauled her back into the wheel chair, and took her to our car and drove her home. We put her to bed. She had been fairly heavily drugged. We asked a neighbor to look in on her.
The next day her neighbor rushed her to Brackenridge Hospital, where they take people who have bad car wrecks or get shot. Barbara was delirious and had a high fever. Her problem was diagnosed immediately by an intern as appendicitis. Her appendix had perforated. They opened her abdomen, took out the remains of her appendix, and and swabbed her out. She almost died from peritonitis. She was in the hospital for a week and a half. The intern suggested that she sue.
She talked about suing the bastards for about a year, but didn't do anything about it.
Then one day, after everyone had forgotten about her appendix, she started shopping around for a lawyer. She found one who would file, but he evidently believed she had a weak case, and he adopted a strategy of stalling until the insurance company would agree to a settlement.
Barbara grew more and more outraged as time went by. Another year passed. A year and a half. Liz was always coming over complaining that her mother had shouted at her, or was being mean to her.
“I guess I provoke her, y'know? I tell her she needs to get on with her life.”
The lawyer told Barbara that the problem with her case was that he couldn't find any doctors who would testify on her behalf as expert witnesses. The intern refused to do so, as had the cocky shift-change doctor. The nurses wouldn't testify. The lawyer said that Barbara's only chance was that the insurance company lawyers did not know for sure that Barbara couldn't get any expert witnesses. Wait, said the lawyer. Be patient.
Barbara fired the lawyer.
She called me up and asked me if I would be a witness in court. I said "Well, I guess so."
She said “I’ve got my trial set for Wednesday.”
In the courtroom on Wednesday the judge asked all the lawyers involved in the cases on the docket to estimate the time that their presentations would take. They all said, “five minutes” or “eight minutes,” “ten minutes at the most.” Barbara stood up and said she was representing herself and her case would take two hours. The judge winced.
“Your case is last.” he said.
All the other cases, six or eight of them, were divorces and took a total of maybe an hour to dispose of.
Barbara said to me in a whisper, “The judge seems very fair. I think I’ll get justice.”
It got to be Barbara's turn, and the judge asked what this hearing was about. Barbara said she had terminated her lawyer and wanted to bring the case to trial. "I have three eyewitnesses," she said, pointing out Kay and me and one of her apartment neighbors to the judge.
The judge looked weary.
“I have to advise you against proceeding to a trial without an attorney. I strongly advise you to withdraw from this, and get a lawyer. It's not too late to do that. I can stop this right now, if you want to.”
Barbara said she wanted to go ahead with a trial.
The judge asked the opposing lawyer if he was ready to proceed. The lawyer had a bad haircut and shiny spots on his suit. The guy could not believe his luck. He looked like a man who has found a hundred dollar bill on the sidewalk.
He looked at Barbara and said “I concur with the judge. I urge you to not bring this to trial at this time, and retain an attorney...but...” and here he looked up at the judge, “if she does wish to bring the case to trial, I am absolutely ready. We can probably move this off the docket pretty quickly.”
The trial began.
Barbara tried to explain what happened. The lawyer objected to everything she said, and the judge ruled most of what she said was inadmissible.
She called me as her first witness. “Tell us what happened in your own words.”
“Well,” I said, “We took Barbara to the hospital because she was worried that someone had poisoned her coffee with cyanide.” The shiny-suit lawyer, poised to leap to his feet and object again, sat back down. I told the story up to the emergency room without any complaints from him. When I got to the part about the words and behavior of the doctor, the lawyer immediately objected and the judge ruled that this part of my testimony constituted hearsay. Inadmissible. The attorney had only two questions for me.
“Are you a doctor?”
“Have you had any medical training?”
The testimony of Kay and the other witness went the same way.
Barbara presented a ringing condemnation of the medical profession in her summation, saying that she had been the victim of a conspiracy of malice, incompetence, and neglect.
The judge made his ruling. Barbara lost.
The trial was over.
Barbara couldn't believe it.
“This is just so unjust,” she said, as she left the courthouse.

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