Make Sure They Know Which Doctor to Call

Misunderstandings over on-call arrangements can become key issues in medical liability disputes. One case shows what a jury can do when physicians disagree on the coverage arrangements they had made.

Dr. A, an ophthalmologic surgeon, was on the hospital’s on-call schedule, but had asked Dr. B to cover for him so that he could attend an event out of town.

The patient, in his mid 30s, arrived at the emergency room at about 9:30 on a Saturday evening, complaining of eye pain. He gave a history of glaucoma. As the ER physician checked for pressure, the pain increased and patient started to see things “swimming before (his) eyes.” The ER physician placed a telephone call to Dr. B, who, based on what the ER physician told him, believed the patient had sinusitis or acute angle closure glaucoma. The ER physician treated the patient accordingly.

After midnight, as the patient’s condition worsened, the ER physician tried unsuccessfully to re-contact Dr. B. Dr. B later testified that he thought that he and Dr. A had an understanding that the on-call arrangement ended at midnight. The ER physician also was unsuccessful in attempting to reach Dr. A.

Another ophthalmologic surgeon, Dr. C, finally arrived on the scene at 3 a.m. When a peripheral iridotomy failed, Dr. C performed an iridectomy. The patient was discharged on Monday with no vision in the eye, to be followed by another specialist. That specialist ultimately diagnosed endophthalmitis. The patient never regained sight in the eye.

All in all, the testimony was clear that Dr. A never received a call. Yet the patient’s attorney refused to dismiss him.

That is because the patient’s expert witness, an emergency room physician, testified in deposition that even if Dr. A did not receive a call, he nevertheless fell below the standard of care for failing to make sure that there was ophthalmology coverage for the period of time when he was originally on call. The expert witness also testified that because Dr. A was the original on-call physician, he needed to make his phone number available to have calls directed to him in the event that the other on-call physician was unavailable.

The defense of Dr. A and Dr. B, supported by separate experts, centered on the remote odds that either physician would have diagnosed endophthalmitis, based on the presentation of the patient at the ER. Even the specialist who ultimately diagnosed endophthalmitis said such a diagnosis made during the evening and early morning hours of the patient’s ER visit would have been extremely unlikely.

The jury saw it differently and awarded the patient significant damages. Then, based on the patient attorney’s argument that Dr. B had become Dr. A’s agent, the jury attributed 25 percent of the fault to Dr. A!

To avoid confusion over on-call duties, physicians should make their arrangements directly with the other physician and then have the arrangements logged.

Doctors deserve their off-time for travel, vacations, and other obligations. An extra measure of care in making on-call arrangements can help make sure that a physician’s travel plans do not include a side-trip to the courthouse.

Gordon Ownby, CAP-MPT’s general counsel, can be reached at gownby@cap-mpt.com.