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This is just bad medical care, assuming the description is correct. Even if they had been given the pain meds, you move the shoulder slightly to see how well th

This is just bad medical care, assuming the description is correct. Even if they had been given the pain meds, you move the shoulder slightly to see how well the pain medicine is working, if it’s not working well enough (= patient shows evidence of significant pain), you give more pain medicine. But it’s hard to get to some level of analgesia that can control the peak of the pain that will happen during joint reduction, but also not cause respiratory depression. That’s why personally I give sedation to my patients instead of just pain medication, that’s what I’d want if I had to have the procedure done. But if in fact it was the orthopedic team that did the reduction, they are not trained to give the same level of sedation as emergency specialists or anesthesiologists. So there is a temptation on their part to give some dose, not titrate to effect, and then just “get on with it” to save time. What they should do, and do in fact do in my institution, is have the emergency medicine doc give sedation, and then they can happily do their procedure without torturing the patient... Or the emergency docs do the sedation and reduction, which we tend to do for patients who don’t require other inpatient orthopedic care. [Edit: Also, Bellevue is a residency training site, so this was probably a first or second year resident (they are the ones that most need the experience of shoulder reductions) https://med.nyu.edu/departments-institutes/orthopedic-surgery/education/residency/rotations https://med.nyu.edu/departments-institutes/orthopedic-surger.... But legally, the attending (supervising) physician is responsible for the care given by all the residents they are nominally supervising]

xmprt 6y ago
What happens to the doctor in cases like this? Seems like a slam dunk medical malpractice lawsuit but then again it's just one word against another and damages are hard to prove since pain is only experienced in the moment.
- ghufran_syed 6y ago
  Depends on what’s written in the notes - but unless the notes specifically say otherwise, the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor. The lawyer would probably need to subpoena the nurse if the notes didn’t have adequate detail to tell one way or the other. About the “pain is only experienced in the moment” - it wouldn’t be hard to find expert witnesses willing to testify that this was unacceptable medical care. But I don’t know enough about the legal aspects to know how that would translate into a claim for damages.
  - srtjstjsj 6y ago
    > the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor. That doesn't make sense to me. The patient is in a shocking situation and intoxicated. More important is that the doctor wasn't even present for the medication so has no evidence at all. Damages are decided by jury's emotions.
- gnopgnip 6y ago
  In most cases like this, nothing for medical malpractice. Calculating damages for pain and suffering is usually based on a multiplier of the "economic" damages, the medical bills or lost income from missed work. So in a case where the pain does not result in a longer recovery(or permanent disfigurement or worse) there are no, or nearly no damages. Because of the way tort reform has worked out, it would be impractical for an attorney to represent you unless you can show $25k+ in medical damages, even if it is clear the provider violated the standard of care and it caused you a great deal of pain. Also even in a straightforward case like this, showing that the standard of care was violated is not clear You could complain to the hospital ombudsman and your insurance co, both to prevent this from happening to others, and because it could reduce your bill.

xmprt 6y ago

What happens to the doctor in cases like this? Seems like a slam dunk medical malpractice lawsuit but then again it's just one word against another and damages are hard to prove since pain is only experienced in the moment.

ghufran_syed 6y ago
Depends on what’s written in the notes - but unless the notes specifically say otherwise, the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor. The lawyer would probably need to subpoena the nurse if the notes didn’t have adequate detail to tell one way or the other. About the “pain is only experienced in the moment” - it wouldn’t be hard to find expert witnesses willing to testify that this was unacceptable medical care. But I don’t know enough about the legal aspects to know how that would translate into a claim for damages.
- srtjstjsj 6y ago
  > the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor. That doesn't make sense to me. The patient is in a shocking situation and intoxicated. More important is that the doctor wasn't even present for the medication so has no evidence at all. Damages are decided by jury's emotions.
gnopgnip 6y ago
In most cases like this, nothing for medical malpractice. Calculating damages for pain and suffering is usually based on a multiplier of the "economic" damages, the medical bills or lost income from missed work. So in a case where the pain does not result in a longer recovery(or permanent disfigurement or worse) there are no, or nearly no damages. Because of the way tort reform has worked out, it would be impractical for an attorney to represent you unless you can show $25k+ in medical damages, even if it is clear the provider violated the standard of care and it caused you a great deal of pain. Also even in a straightforward case like this, showing that the standard of care was violated is not clear You could complain to the hospital ombudsman and your insurance co, both to prevent this from happening to others, and because it could reduce your bill.