Does a physician’s use of differential diagnosis raise a medical malpractice issue in Louisiana? That question is at the center of a recent medical malpractice case out of Lake Charles. The Louisiana Third Circuit Court of Appeal addresses liability attached to a method of clinical diagnosis known as a differential diagnosis.
On February 23, 2011, after experiencing two seizure-like episodes, Ms. Judith LeBlanc was seen in the emergency room of CHRISTUS Health Southwestern Louisiana (St. Patrick’s Hospital) by her primary care physician Dr. Lewis. Ms. LeBlanc was being treated for a jaw infection and scheduled for a tooth extraction the next day. Dr. Lewis ordered several tests over the next few days to rule out multiple potential underlying conditions. Although Dr. Lewis made a differential diagnosis that included sepsis as a possibility, Ms. LeBlanc was not treated for sepsis because she displayed no signs of it. Two days after her discharge, Ms. LeBlanc developed seizure activity and cardiopulmonary arrest and eventually passed.
A medical malpractice lawsuit was filed by Leblanc’s family. As part of the lawsuit, a Medical Review Panel met and found that neither St. Patrick’s nor Dr. Lewis breached the standard of care. St. Patrick’s and Dr. Lewis relied upon the Medical Review Panel’s findings in filing motions for summary judgment to dismiss the lawsuit. The Fourteenth Judicial District Court for the Parish of Calcasieu granted those summary judgment motions and Leblanc appealed.
In medical malpractice, a defendant must show that there is an absence of factual support for one or more elements essential to a plaintiff’s claim to show that there is no genuine issue of material fact. There are three elements the plaintiff must show, by a preponderance of the evidence: (1) the standard of care applicable; (2) that the defendant breached the standard of care; and (3) that there was a causal connection between the breach and resulting injury. See Djorghi v. Glass, 23 So.3d 996 (La. Ct. App. 2009).
Leblanc’s family argued the District Court erred in finding that Dr. Lewis did not diagnose Ms. LeBlanc with sepsis upon hospital admission, even though his treatment plan was to treat sepsis with antibiotics and monitor. The Third Circuit rejected the plaintiffs’ position that Dr. Lewis diagnosed Ms. LeBlanc with sepsis because of the nature of the differential diagnosis that Dr. Lewis conducted.
A differential diagnosis is only a list of potential disorders that could be the cause of presenting symptoms and considers medical and family history. A differential diagnosis is used to help diagnose physical or mental health disorders that cause similar symptoms. Thus, a differential diagnosis (such as sepsis in this case) that has been ruled out does not establish a medical diagnosis for which a standard of care follows. Accordingly, the Third Circuit agreed with the District Court that Dr. Lewis did not breach the standard of care by failing to treat a condition that was merely one of several possible diagnoses.
Justice Cook dissented, stating that the majority mischaracterized the issue. Instead, Justice Cook argued that there were genuine issues of material fact left unresolved. Justice Cook pointed to the nature of sepsis and that Ms. LeBlanc showed all but one criterion that is present when classifying someone with sepsis. Justice Cook looked at the evidence to point out that even though Dr. Lewis said he saw no symptoms that Ms. LeBlanc had sepsis, his testimony is fundamentally at odds with Ms. LeBlanc’s own medical record and the Leblancs’ expert testimony.
The dissent also stressed that Dr. Lewis knew that Ms. LeBlanc had an infection, had written a treatment plan that included administering antibiotics, and then did everything in that treatment plan except for prescribing antibiotics. It was the inclusion of administering antibiotics as part of the treatment plan and that Ms. LeBlanc demonstrated most signs of sepsis that—with plaintiffs’ expert testimony—the dissent believed raised a genuine issue of material fact as to the proper standard of care.
While the dissent brought up significant facts for discussion, the Third Circuit opinion came to a different conclusion. Medical malpractice claims can be challenging and require an excellent attorney to clarify the applicable standard of care required for a claim to proceed.
Additional Sources: JACQUELINE BRENNER, ET AL. VS. DR. RONALD M. LEWIS, ET AL.
Written by Berniard Law Firm Blog Writer: Elisabeth Tidwell
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