By M. Marilyn Ambroise, JD, MHS, PA-C

It is well-established that a health care organization’s policies and procedures can serve as evidence of the standard of care; and their violation can lead to a finding of negligence. However, even when there is no policy violation, a hospital could still find itself in litigation over allegations that a given policy failed to meet the standard of care. A recent North Carolina medical malpractice case illustrates how this could happen.

In Johnson v. Wayne Memorial Hospital, Inc., the hospital’s policy on the follow-up of diagnostic tests came under close scrutiny. The patient presented to the emergency room complaining of pain. He had a history of sickle cell anemia, a disease associated with intermittent episodes of pain. Multiple studies were ordered including a chest x-ray. The emergency room physician interpreted the chest x-ray as normal and discharged the patient. A radiologist read the patient’s chest x-ray a few hours later and noted a left lobe infiltrate which he did not consider “dangerous, ominous, or concerning.” Per policy, he did not immediately report the discrepancy. Instead, the Nurse Supervisor shared the discrepancy with an emergency room provider about 14 hours later. By then the patient had already returned to the hospital and was admitted. The patient was diagnosed with acute chest syndrome, a life-threatening complication of sickle cell anemia. A day later, the patient died. The administrator of the patient’s estate sued alleging, in pertinent part, that Wayne Memorial Hospital’s timeframe for reporting x-ray interpretation discrepancies failed to meet the proper standard of care. Generally, it took up to 24 hours after an emergency room physician’s x-ray reading before an emergency room provider would be informed of the radiologist’s conflicting interpretation. This was within policy as long as more immediate notification was not warranted in the radiologist’s opinion.  

In order to show that the timeframe for reporting x-ray interpretation discrepancies--pursuant to the hospital’s policy--fell below the standard of care, the plaintiff needed to show that the policy “was not in accordance with the standards of practice among members of the same health care profession with similar training and experience situated in the same or similar communities under the same or similar circumstances at the time of the alleged act giving rise to the cause of action.” N.C. Gen Stat. Section 90-21.12(a) (2011). At trial, the plaintiff’s expert witness admitted that he had not made any inquiries into the timeframe for reporting x-ray interpretation discrepancies at other hospitals. As a result, the trial court granted a directed verdict in favor of Wayne Memorial Hospital and dismissed the case. The Court of Appeals of North Carolina agreed stating: “plaintiff failed to offer any evidence of either (1) the standard of care to which a hospital in the same or similar community should adhere in its process for the review of x-rays, or (2) the hospital’s breach of the standard of care.”

Setting aside the hospital’s victory, this case serves as a good reminder for health care organizations to take standards of care into strong consideration when drafting or reviewing policies and procedures. Failure to do so could place them at greater risk for claims of medical negligence. One of the ways in which health care organizations can ensure that their policies and procedures are in line with standards of care is by comparing them with those of similarly situated health care organizations. If they leave this to expert witnesses in possible future litigation, they may not fare as well as Wayne Memorial Hospital did in this case.