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    Are covering residents negligent for missing complications?

    I covered for my supervising physician, am I liable?

    Dr. Jones is a dermatologic surgeon who oversees a recently established ASDS Cosmetic Dermatology fellowship program. He recently performed laser lipolysis on the thighs and knees of Mrs. Smith. Mrs. Smith is a healthy 50-year old women and is on no medications. Her cardiac and pulmonary function were both perfect.   The procedure, performed under tumescent local anesthesia, went smoothly and lasted less than three hours.  The patient left the office without any difficulty at 11:00 a.m. in the morning. At 4:00 p.m. that same day, Dr. Jones called Mrs. Smith to check on her post-operative course. She reported some discomfort behind one knee, but otherwise no difficulties. At 6:00 p.m., Dr. Jones called his already board-certified cosmetic dermatology fellow (Dr. Owens) and signed out to him. He discussed Mrs. Smith’s surgery with Dr. Owens.

    Read more: What happens when residents' errors go unreported?

    At 8:00 p.m., Mrs. Smith called Dr. Jones’ office with a concern about her surgery. Dr. Jones’ answering service immediately paged Dr. Owens, the covering physician. Dr. Owens returned the page within 15 minutes. In their discussion, Mrs. Smith described the discomfort and some tightness in her chest. Dr. Owens discussed the situation with Mrs. Smith, explained he is the “fellow” and reassured her that such findings are probably are unrelated to her treatment.  He suggested she try to go to sleep and call Dr. Jones in the morning.

    The next morning, Mrs. Smith awakened to find she was short of breath. She immediately returned to Dr. Jones’ office. He immediately sent her to the emergency room. She was found to have a deep vein thrombosis behind her knee, multiple pulmonary emboli and was in congestive heart failure. She survived, but is now a cardiac cripple.  Had the deep vein thrombosis been evaluated the day before, it is possible the pulmonary emboli and heart issues may never have occurred.

    Mrs. Smith brings a negligence cause of action against both Dr. Jones and the covering fellow, Dr. Owens. The basis of her case against Dr. Jones is that he was in a “joint venture” with Dr. Owens. After all, they cover each other’s practices every night. It should be noted that there are no payments made for the cross-coverage. This is just what dermatology fellows and residents do everyday.

    Next: Is Dr. Jones liable?

    Enhance your knowledge about negligence:

    Did negligence cause patient's death?
    Who takes the blame when covering physicians are negligent?

    David J. Goldberg, M.D., J.D.
    Dr. Goldberg is Director of Skin Laser & Surgery Specialists of New York and New Jersey, Director of Mohs Surgery and laser research, ...


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