My patient lived—so she sued me

May 6, 2005

By mistakenly predicting a patient's imminent demise, this doctor nearly ended up in court.

I'd been practicing in my small Midwestern farming town for about 10 years when I began treating a woman I'll call Millie. Then 66, she could be classified as a "frequent flier" in my office. Over the roughly six years I was involved in her care, she averaged at least one visit a month, in addition to several hospitalizations.

When Millie first came to my clinic, I treated her for depression and heart disease. Over the next few years I also diagnosed PVD, COPD, HTN, diabetes, osteoporosis, and finally lung cancer. Managing Millie's care was challenging; she wasn't very compliant about referrals, or following my recommendations for lifestyle changes.

I'd also cared for Millie's husband, Harry, over the same period, and had helped him avoid some serious medical problems. Like Millie, he wasn't very compliant either, and he was also quite demanding. Although he typically brought Millie in for each of her visits, from what I learned from them over the years, they didn't appear to have a very close relationship. In fact, Millie once told me that if she were 20 years younger, she would divorce him. Given their limited social activity, I gathered that her visits to my office were a welcome escape from her confining home life.

Millie's workup and treatment involved various specialists, some of whom I wasn't familiar with because they practiced outside our area. But I received periodic reports from them regarding her treatment, which I read and filed in her chart. When I felt it was necessary, I discussed her condition with her other physicians. But for the most part I let them manage her cancer, and continued to deal with her chronic problems.

I finally recommend hospice care Millie's cancer treatment proved difficult, and she suffered hair loss, GI symptoms, and emotional problems. At one point, she stated that she wouldn't agree to any more chemo or radiation therapy, or any other aggressive treatment. While her condition fluctuated, she was generally deteriorating. She had problems with basic activities of daily living and became increasingly confused.

At one point, when I was seeing Millie more frequently, Harry pressured me, saying that "something" needed to be done about her deteriorating condition. I even had a phone conversation with one of their daughters about the need for some intervention. I suspected that Millie's cancer wasn't completely eradicated, and that brain metastases were likely. But a repeat head MRI failed to confirm my suspicions. I spoke with Millie's oncologist, who suggested I try some Decadron to help treat her symptoms. I did, but it didn't help much.

As Millie's condition continued to decline, I grew pessimistic about her overall prognosis. When Harry and her family insisted again that something be done, I finally suggested that she enroll in a hospice program. Although I never told Millie that I felt her death was imminent, I didn't dispute her when she told me she knew she was going to die. Since she was still fairly lucid, I recommended that she get her affairs in order, but encouraged her to continue to engage in exercise and other activities.

Millie's family decided to have her move in with her daughter, who lived downstate, and to enter a hospice program in that area. But when they tried to arrange for it, the hospice administrators concluded that Millie didn't qualify for the program since her recent MRI didn't show evidence of brain metastases.

Harry then became quite angry with me. He came to the clinic and demanded that I transfer Millie's records to another doctor, and told me he planned to sue me. I wasn't too concerned by his threat at that point, however, since I was sure my treatment of Millie had been totally appropriate.