Do You Know All That Is Going on in Your Office? by Gordon Ownby, JD
Sometimes, physicians within Individual Practice Associations may need to make sure that the IPA has not become involved in directing patient services that are contrary to a physician’s own wishes.
Fourteen-year-old Kari R (not her real name) began seeing Dr. FM, a specialist in family medicine, for complaints of acid reflux, chronic tiredness, and lack of energy. Per her mother’s history, Kari had been diagnosed a year earlier with fructose intolerance and acid reflux but had been found negative for gluten intolerance, Giardia, and H. pylori. Dr. FM ordered labs and referred Kari to a pediatric dietitian and the pediatric GI clinic at the nearby medical center.
Several months later, Dr. FM referred Kari to an allergist, who diagnosed allergic rhinitis, chronic sinusitis, nasal congestion, and allergic bronchial asthma. The allergist ordered a series of immunotherapy injections. These injections were given in Dr. FM’s office by several medical assistants and a nurse practitioner from antigen packets provided to Kari by the allergist and cold-stored in Dr. FM’s office.
On her seventh visit for her allergy injections, the young patient developed an acute rash reaction at the injection site and began to cough and complain of chest tightening. Dr. EE, who was Dr. FM’s employee and in the office during the MA’s injection of the patient, responded by administering oxygen via nasal cannula, Benadryl and epinephrine. Dr. EE also gave the patient a nebulizer treatment of Xopenex. A call to the allergist resulted in instructions similar to the treatment that Dr. EE had by then administered. The patient rested in the medical office for several more hours.
While the patient recovered from the incident, Dr. EE told Kari’s mother that her daughter had received the antigen of a different patient, also a “Kari R.” Evidently, the antigen packets of the various patients listed full patient names in very small type, with the first name and last initial printed much more prominently. Both “Kari Rs” were taking the same antigen for cat allergies, though the other patient’s antigen was of a stronger concentration.
The patient visited her allergist’s office later that day and received prescriptions for albuterol, Zyrtec, and a Medrol Dosepak. That evening she went to the urgent care center for hives, which continued off and on for the next day. The patient sued Dr. FM for negligence and later added the MA as a defendant.
