week 5 discussion post PBH 305


On the evening of December 14, 2008, Phineas, a sixteen-year-old patient, was brought into the emergency room of Princeton Grassland Hospital in Princeton, New Jersey suffering from seizures and unexplained pain.  When the attending physician was uncertain of how to proceed, Phineas was referred to Dr. Home, an infectious disease specialist employed by the hospital. Dr. Home had experienced a long day in the clinic diagnosing coughs and colds and, after reading Phineass medial chart, sent his subordinate, Drs. Brown and Cameron to examine him. He did not examine the patient himself. Brown and Cameron examined Phineas thoroughly and discovered that he was suffering from increased intracranial pressure.  After a CT scan, they noted that he had several small nodules in his brain. Brown was certain that the nodules were cancerous tumors, but Cameron thought that they looked unusual and wanted to conduct a biopsy to be certain. When the two were unable to agree on a course of action, they returned to Dr. Home for a decision. 

Dr. Home, grouchy at being taken away from the soap opera he was watching in the employee lounge, took three Vicodin and reluctantly sat down with Brown and Cameron. The ERs head nurse, nurse Adams, urged Home to go see Phineas but he would not. Adams wanted to report Home for failing to see Phineas, but she was afraid she would get in trouble so she decided to just wait it out. 

After listening to Brown and Cameron, and without speaking to the patient, Home ordered anti-convulsive medication to control the seizures and instructed Dr. Brown to perform a biopsy on the suspected tumors to determine their origin. If the type of cancer that the doctors suspected was the cause of the nodules, the anti-convulsive medication should have eliminated the seizures. Brown and Cameron informed Phineas that he probably had cancer but that they wanted to be certain, and he consented to the biopsy.  

On December 15, Brown was about to make his initial incision to begin the biopsy of Phineass brain when Phineas cried out that there were ghosts in the room and then began to seize. Because the seizures had returned and the patient was now suffering from hallucinations, the team knew it was not cancer. They again consulted with Dr. Home. Home ordered Brown to perform some laboratory tests for infection and he went to see Phineas about the ghosts. 

Phineas was becoming increasingly concerned about his condition and was upset at having been told he had cancer when he did not. He was also in a great deal of pain and exhausted from the seizures. He explained to Dr. Home that every once in awhile he would see a dark ghost in the room, and then it would disappear. When Home began to make fun of Phineass fear of ghosts and question him about illegal drug use Phineas grabbed Dr. Home by his shirt and pulled him close to punch him in the face. Inches from Phineass face and before the blow was thrown, Dr. Home noticed something swimming in Phineass eye.  After further examination, Home diagnosed Phineas as suffering from neurocysticercosis coupled with ophthalmic cysticercosis, two forms of T.solium infection. Phineas was treated with anti-convulsives coupled with antihelminthic chemotherapy and made a full recovery. 

First, please discuss the duties and responsibilities by which the healthcare professionals presented in this scenario are bound. Once you have elected a responsibility, please describe what the duty was and whether or not it was breached.  If you determine the duty was breached, please describe which member of the medical staff breached that duty.  If you determine it was not breached, please state why it was not and what was done correctly.

Next, please list any medical errors or professional misconduct that occurred in this scenario and the potential consequences to both the patient and the medical professional.