Every Minute Matters

Voiceover: Every minute someone’s life takes a terrifying detour, not down a dark alley, but into the sterile, bright halls of healing. They walk in, seeking care and find themselves plunged into a nightmare. Most malpractice claims in hospitals are related to surgical errors, whereas most claims for outpatient care, which accounts for more than half of the paid malpractice claims, are related to missed or late diagnosis. 

Now, before you raise a pitchfork at every white coat you see, let’s be clear. This isn’t an indictment. It’s a revelation. Because the truth is, any provider, any nurse, any human being capable of brilliance is also capable of a mistake. This is about understanding why and using that knowledge to build a safer future for every patient who walks through those doors. 

Welcome to FHEA’s Scrubs and Subpoenas: Tales from the Witness Stand, a podcast where we’ll peel back the sterile sheets and delve into the real stories of medical malpractice. Each episode a cautionary tale, a blueprint for change, a reminder that even in the darkest corners of human error, there’s a light, the light of knowledge, the light of empathy, the light of a future where healthcare becomes not a gamble, but a guarantee. 

So join us as we dissect the mistakes, illuminate the flaws, and ultimately learn to heal not just bodies, but the very system itself. 

Jannah Amiel: Welcome to another episode of Scrubs and Subpoenas: Tales from the Witness Stand. I am your host, Jannah Amiel. And joining me is our esteemed guest, Dr. Sally Miller. Dr. Miller, how are you? 

Sally Miller: I’m very well, thank you. And you? 

JA: Good. Thank you. Thank you. Now, if you listen to our podcast before you know that we are looking at or talking about real stories, real patient cases, where things have gone wrong. And listening to the intro of our podcast, you know that we’re talking about when medical errors actually happened, right? So taking it beyond those medical errors that we all take in, we kind of like poo poo a little bit, and talking about how this really shows up truly in real life, in real practice. 

And so Dr. Sally Miller is going to share a case with us today. And as we listen to that, as we kind of think about that, I’d love for you to follow along and and think about, to yourself, where and how and how did we get to this point. Right. And what may have you done different? What could have been done different? 

And, and really recognizing that, truly, these types of errors, these types of mistakes can happen to any of us, right? Any of us that work in practice. Any of this could happen to all of us. So, it is a really good opportunity for us to listen and learn and recognize that we’re not exempt, we’re not immune. But hopefully these types of stories and these types of cases can help us practice a little bit safer, a little bit better, in some type of way. 

Dr. Miller, we’d love to hear the case. We’d love to dive in and let’s see what you got for us today. 

SM: Okay, so I do have another one for you, unfortunately, with, with, with a really unhappy outcome. So, this is a case of a 49-year-old male patient who presented as a walk-in to the emergency department. He walked in at approximately one o’clock in the afternoon and he reported to the initial, you know, to the counter, to the front counter that he has an allergy and he identified the allergy. 

He knew what he was allergic to, that he was exposed to it a couple of hours ago. It was unintentional. But in retrospect, he realizes he had this exposure and that now his face is swollen and his stomach feels queasy and that this always happens before he swells up really, really bad. So that’s what he told the person when he walked in, you know, the person behind the counter, not, not, not, an RN or an LPN or a you know, a licensed healthcare provider, but just whoever was doing patient intake, he told her, I have this allergy. 

This has happened to me before. It gets really, really bad. And I just was exposed and I feel this way again. Here I am. So he was, of course, brought in. You know, he saw a triage nurse and almost an hour later, he was actually, he was seen for the first time by the APRN. So now, you know, who knows, who knows where that delay came from. 

But for someone who is having a progressive allergic reaction involving swelling of the face, it was 50, five oh, minutes from the time he was documented to have walked in to the emergency room to the time that he was seen. So, you know, 50 minutes later at 1:50 p.m. the APRN examines him and she notes his self-report. So, the APRN documents in her record that the patient reports that he has had this allergic reaction before, that his face and his mouth, and his throat swell up really bad and that he’s having it again and he feels it coming on. 

So at that point, this is the first APRN-documented encounter. And she notes his chief complaint of an impending allergic reaction. She notes his self-report right now of a sense of swelling in the back of his mouth. She notes his self-report that this has happened before, and he’s had to come in to the emergency room. She further documents that he appears alert and comfortable. 

There is a physical examination to include, like heart and lungs, and the usual garden variety physical exam. But there is, there is no examination of the oropharynx. There’s no, “Open your mouth.” You know, “Open your mouth.” Use of a tongue depressor. There’s no documentation of the condition of the oropharynx, which it just, it stands out. And again, I always want to be so clear in these episodes. 

I’m really not being judgy. It’s, it’s easy. It’s easy to look back at later and say, shoulda, shoulda, shoulda, but, but part of why we’re all here is, you know, is to learn something from this. So, you know, just think about this for a moment in retrospect, as I’m sure this APRN did, the patient comes in reporting an impending allergic reaction that he’s had before where he gets really bad swelling and there is no apparent exam of the mouth or if there was an examination of the mouth, it wasn’t documented. 

And either way, this is, I mean, it’s like someone coming in complaining of chest pain, with the history of an MI and there’s no EKG documented, you know, it’s kind of like a basic staple there. So, she did notice, she did note some moderate swelling of the cheeks externally, but no documentation of the oropharynx or the neck or the quality of speech, you know, with, with impending anaphylaxis and oropharyngeal swelling. 

There’s a lot of times muffling the voice, none of that kind of stuff is there. So based on this, the physical exam and history is limited, but based on what’s documented there, the patient has ordered Benadryl, Solu-Medrol, and Pepcid IV push. So for the listening audience, just, you know, consider if something is missing. The patient is ordered Benadryl, Solu-Medrol, a steroid, and Pepcid, which is an H2 receptor antagonist. 

And those are administered IV 40 minutes later with no, no, no apparent documentation as to why the delay or why this was ordered. Now, no further physical exam is documented, it, but 40 minutes later, epinephrine was administered.  
 
JA: My gosh.  
 
SM: Okay. So, 40 minutes after the original exam, which occurred 50 minutes after the patient came in. So, you know, we’re, you know, between one and a half and two hours from the time the patient walked in. 

And again, don’t know why. I just know what is, and is not, documented. And that’s the way it’s documented. There’s, there’s no further documentation after that epinephrine injection, you know, about the patient’s response to it. You know, symptoms improve, they didn’t improve. And so, it’s just not there. And again, it’s for all of us, you know, you and me and the listening audience to think, wow, how could that have happened? 

And what significance could that have? Later on, one hour and five minutes after the epinephrine was administered, there is documentation that a liter of normal saline is given and another ten milligrams of Decadron. There’s really no, no documentation as to why there is no further physical examination documented. There’s no report that there is a, a progression of symptoms or a worsening of symptoms or anything like that. 

It’s just that an hour and five minutes later, this is given. About 20 minutes after that, the next piece of documentation as the patient is moved from the fast track to the main emergency department. So, you know, one might assume that something has happened, but we don’t, we don’t know what’s happening here because there’s no documentation, just, “Patient is transferred to the main emergency department and soft tissue x-ray of the neck is ordered.” You know, in a soft tissue x-ray. 

I mean, it’s a fast way to try to get a quick look of any swelling, you know, of the tissues around the oropharynx. And it’s a, it’s not the most definitive look, but it’s a quick one. It’s a quick way to get an impression right off the bat. So now, just to put this in time perspective, we are almost three hours after the patient first walked in. 

JA: Yikes. 

SM: He’s transferred to the emergency department and soft tissue films are ordered. And now there, now there is an order. So, literally five minutes after the soft tissue x-ray film order is entered, there’s an order admitting him to the hospital, right? Not just the ER, but admitted him to the hospital. Fifteen minutes after that the nurse practitioner that has been following him, you know, since the point of admission, documents a detailed discussion with the patient regarding certain historical points, like the physical examination findings, any diagnostic or any diagnostic evaluation or workup, the need for further workup. 

Now, the actual findings aren’t documented. It’s more like documenting a conversation with the patient that we’re going to do some more testing. We have to gather some more information at that time. At that time, five minutes after he’s ordered admitted to the hospital, she documents that his symptoms appear to have improved. So, it’s really hard to follow the progression of events here because we, you know, we go from the, the Decadron, the Pepcid, and the Benadryl, like everything but epinephrine, to then 40 minutes later, the epinephrine. 

And then an hour later, IV fluid and more Decadron like, with no narrative about what’s happening, no patient examination at all. And then the next thing that happens an hour later is that he’s admitted to the hospital and soft tissue films are ordered. And then 15 minutes after that, the APRN documents that he appears, that his symptoms appear to have improved. 

Five minutes after that, five minutes after documenting that the symptoms have improved, the APRN documents that he now has a partial obstructed airway, posterior pharyngeal swelling that is marked, you know, that’s the way it’s written. Marked posterior pharyngeal swelling, mild swelling of the right and left lateral anterior aspects of the neck. That’s it. No other assessment findings are documented. 

There’s no like, no general assessment as to the level of distress the patient, no short of breath. Is there any respiratory impairment? Is there any muffling of the voice? Is there, are there, any mental like, there’s nothing else there except what I just shared with you. And then five minutes after that, there’s documentation that the voice is muffled. 

The next documentation is an hour and a half later. There’s no further medication administration, there’s no further physical examination, like there’s no other documentation at all until one hour, about an hour and 20 minutes later, the patient was given more Decadron. And then 10 minutes after that, he was transferred to the operating room. So, that’s what’s documented like that. 

That’s what we have to look at in the chart, the depositions that were taken, you know, of all the various interested people. Apparently, he was taken to the emergency room emergently to establish an airway, because by the time somebody tried to intubate him, he was so edematous that they couldn’t pass an ET tube in the emergency department. 

So, he was sent emergently to the operating room for an airway that failed and the patient died in the operating room. 

JA: Whoa, whoa. All right, we got it back all the way up. That is, that is pretty heavy. Now, immediately again. And you’re right. Like, it’s easy to sound judgy, but it almost sounds like the textbook presentation of what we learned in, in nursing school. Right, about anaphylaxis like this. This immediately sounds like anaphylaxis. Immediately. It sounds like someone, even if it’s not the worst allergic reaction. 

It sounds like it is, like the first thing that we should have done, would, would be epi the, the first thing that. That is. Wow. And it’s so much time, Dr. Miller. So much time. I’m trying to fill in the gaps of the beginning to the end. And there’s so much time that’s gone by. I don’t even know where to begin with that. 

SM: It is. I mean, the business of from 1:00 to 1:50, I mean, first of all, with, with anaphylaxis, as you know, time is of the essence, right? I mean, time, time is enormous. Yeah. And time, the thing we never have enough of. Right. But time is huge. Now between one and 1:50 we, we don’t know who communicated what to whom. 

So, we can’t we can’t really learn anything from that. I mean I suspect that, been a long time since I worked in an emergency department. But, you know, there’s, I suspect that the response would be, well, we can’t expect the front desk to know and the front desk can’t come back and notify everybody. And the man walked in and he apparently was conversant and not in any acute distress. 

So, okay, you know, there’s that one to 1:50, what can we say? But, but interestingly, the diagnosis of, the diagnosis of anaphylaxis never appeared on the chart until after the patient died. What, what the working diagnosis up until that point was acute allergic reaction. And there is a difference between an acute allergic reaction and an anaphylactic reaction. And, and anaphylactic reaction, by definition, is life-threatening. 

And an anaphylactic reaction by definition typically includes either, you know, in addition to that, like the angioedema, you know, edematous symptoms, typically there’s either IgE-mediated bronchoconstriction that will include, you know, a wheezing or some difficulty with respiration or IgE-mediated vasodilation which will produce, you know, hypotensive, shock and, you know, anaphylactic shock that way. But it doesn’t start that way. 

And we have to remember that it can happen. It happens very, very fast. You can go from 0 to 60 just like that. Then, there is a bit of a misconception that if anaphylaxis is going to happen, it happens immediately, which really isn’t true. I mean, and if anaphylaxis can develop easily within the first 24 hours after exposure to an allergen. 

And so it may be early on that it doesn’t look like textbook anaphylaxis. But, you know, as, as the providers, we need to recognize the risk for that. Something that I didn’t mention to you because nobody noted it in the chart. You know, what I just shared with you was the chart recitation of events. But the patient had two episodes of anaphylaxis treated at that same emergency room within the last two years. 

JA: He had a history of it. 

SM: He had a history of it at that facility, you know, in that emergency room. 

JA: You could have looked at a chart essentially. You would have had, like, history to see that it’s happened before. Wow.  

SM: And typically, typically, you know, I don’t know for sure because I don’t practice in that emergency room. But typically a life-threatening circumstance like that is usually very apparent, you know, when you. But, you know, very quickly when you, if you are looking at old records. Now, remember, he told everybody it happened before.  
 
JA: Yeah.  
 
SM: And so the fact that he told everybody it happened before and that it involved swelling in the face and swelling in his throat, I mean, you know, in retrospect, something we can all learn from this is if somebody tells you it happened in your facility before, it’s worth a few minutes. 

I mean, it’s all, it’s all computerized now. It’s really easy to access those old records. So, that, that was probably, I think it’s fair to assume it was readily available.  
 
JA: Yeah.  
 
SM: Had anybody, had anybody tried to look for it. So, even if it wasn’t, even if, even if we presume that, that, that nobody knew that it was called anaphylaxis before he told them that it had happened before. 

And so if you’re going to give a Benadryl, a Solu-Medrol, and a Pepcid. Why not the epinephrine? Like if you think this is happening to the extent that it needs the rest of the IV cocktail, I mean, the Benadryl, the steroid, and the H2 blocker, those are all, those are all used to help abort the second wave of that stress response. 

I mean, there’s a primary stress response and a secondary stress response that, that constitute anaphylaxis. Epinephrine is used for immediate, you know, immediately to manage the consequences of the acute response, the Benadryl and the steroids are used for later on. So, it’s really not clear why the epinephrine wasn’t there in the first place. When in doubt, plunk the epinephrine in. And, you know, when you don’t, open up. 

JA: Anything wrong in doing that first? Would there be any reason or anything incorrect if you thought somebody was having an allergic reaction, even if you thought it was acute versus anaphylaxis? Is there anything, any harm, in just giving epi?  

SM: No. Yeah, no, no, there’s not. There’s not. I mean, if you, if you’re not sure if you’ve got impending anaphylaxis, I don’t know if the patient is in hypertensive crisis maybe, or, you know, because it will, it will accelerate your blood pressure and your heart rate. But I mean, that’s a real stretch. And if you have even the remotest inclination, even if you think this might be anaphylaxis, the answer is boom. 

And in this circumstance, you know, the patient tells you that the back of his, that he feels swollen in his mouth, in his throat, and that this happened before. And he felt this way before it got really swollen, that that’s a reason for anaphylaxis right there. So, no, I mean, I can’t think of any, any realistic reason why he didn’t get anaphylaxis. 

JA: Wow. 

SM: But he didn’t. 
 
JA: Wow. So we have the Benadryl, we have the Solu-Medrol. We’ve got the Pepcid, and then it sounds like more time. And. 

SM: Forty, 40 minutes. Yeah. Forty minutes later, he got the epinephrine and no documentation as to why. I mean, I just. I listen, I guess anything is possible, but the only reason I can think of for that is that they didn’t have it readily available. But I can’t imagine not having epinephrine readily available in an emergency room.  
 
JA: Yeah, right, in the ER. 

SM: You know, I. Yeah, I can’t. I can’t imagine why that would be the case. I suppose it’s possible that it was given at the same time and not documented. But again, how, why, like even if somebody is documenting retrospectively here, because you know how it goes, you don’t always give drug, type note. Give drug, type note. 
 
JA: Right. 
 

SM: You know, you give, you do your stuff, and then you go make your note. Although, now with everything being at the bedside and, you know, computers being right there, it really is often very contemporaneous. But, but even if this you know, even if it wasn’t, I can’t think of any reason why, why you would document the other three at one point in time and then document the rest of it 40 minutes later. 

JA: Yeah.  
 
SM: That’s the epinephrine. Forty minutes later, if anything, the other way around. I mean, if one thing has to be entered in that record, it’s the epinephrine. 

JA: And then the detailed discussion. You know, I heard you say that the APRN had a detailed discussion with the patient, and I have to be honest. So, working, I’ve worked in the ER, always with peds. But I will say of all, of all the patients that I’m rolling through, it’s the most difficult to talk to somebody who is having an allergic reaction. 

So it’s hard to kind of conceptualize that happening. And I’m imagining, too, like, is this patient not hooked up to, like, monitoring devices? Like what other things were missing here. 

SM: In that, well, remember for the first for the for the for most of this, actually, he was at a fast track room. 

JA: Oh right. 

SM: You know, he wasn’t he wasn’t in, even in the main emergency department. He didn’t go to the main emergency department unti,l like it was close to three hours after he walked in the door. From the time he went to the main emergency department, to the time that he clearly, that there’s clear documentation that he’s deteriorating. It was only about 20 minutes. 

So, I mean, I think I gave you some times as a frame of reference, he walked in the door at one, saw the APRN at 1:50. The note admitting him to the main emergency room is at 3:56 p.m. and then at 4:17 is when the APRN documents the muffled voice. And just prior to that, minutes, it really almost looks like, the going back and adding stuff, like just as it as she thought of it or as she as she thought to include it. 

But it did, it doesn’t give, it doesn’t give a real easy time trail to follow, which, you know, again, the learning point for all of us is three years later, three years after these events when nobody remembers what happened, when all anybody has to look at is what’s in writing in front of you. So even if you are documenting it later, throw in the times, you know? 

So, timestamp of the note might be 4:00, but in your note at 2:30 p.m. did x, y, z. 
 
JA: Right.  
 
SM: You know, you know that type of thing. And we don’t have that here. But all we can see, all we can see is that somewhere around three hours after he came in, there was enough of a deterioration. This marked pharyngeal swelling, partially obstructed airway, I would bet is probably interpreted from the film of the neck that had been ordered. 

JA: Wow. You know, this is, this is particularly tough in the sense of, again, trying not to judge like mistakes do happen, but it’s, it seems like it’s so clear. It just seems like it’s so clear that this is an allergic reaction. I mean, for goodness sakes, people can carry around their own epinephrine and, you know, and that way that even if you weren’t sure, like there was nothing, nothing wrong in doing that. 

And so much time has gone by. And the thing that’s like blazing in my brain is. ABC’s. ABC’s. They, we see, like that’s just beaten to our head, right? That the priority there is an airway issue or an impending one that you think or anything like that, that you have to act really soon because you don’t have time. If there’s, if there’s an allergic reaction like this happening where it’s compromising, moving air, you don’t have time. 

SM: And it can go again. It can go from 0 to 60, boom, just like that. And so I don’t know, I, I, I don’t I’m a little like, I wonder why there’s so much time where there’s no further assessment documented. You know, more stuff given, but no documentation about why except that this note at, at 1609, nine minutes after four, like just 15 minutes after being transferred to the main ER and then being admitted, there’s the documentation about symptoms have improved. 

You know, like how does that, how does that fit into the mix? I also, you know, you have to wonder why there was, there’s a documentation of epinephrine given at 2:30 and not again, even after the deterioration of symptoms, whenever they occurred. After the deterioration is acknowledged, there’s no more, there’s more Decadron given, but there’s not another epinephrine injection. 

JA: Wow. And, you know, I think this, this very unfortunate story really rings true to what you mentioned in our first episode when you talked about the importance of clear documentation, like the importance of documenting that if you didn’t document it right, it didn’t happen. But even creating like, this clear narrative of what went on, because in something like this, it is very difficult to, to follow and it’s very easy to say, well, this was an allergic reaction. 

This is a quick thing that we could have done, a quick intervention to potentially have a different outcome. But in looking back at this, it’s hard to say what was done and what wasn’t done because the documentation seems so spotty in it and that that seems really important. You know, that’s an important takeaway for me. 

SM: It is really, it’s really impossible. I mean, if you if you take it as it’s presented, which is all there is, you know.  
 
JA: Yeah.  
 
SM: I mean, of course, there’s deposition testimony from everybody. And deposition testimony is sworn testimony. And, you know, we have to assume that, that people are telling the truth when they are deposed. And one thing that, you know, that the APRN had said that, and I’m paraphrasing here, but generally speaking, she said that at one point somewhere like just before that, epinephrine was given, she ran it by the emergency room physician. You know, “What do you what do you think I should do?” And that he told her to give the epinephrine. He says that didn’t happen at all. 

JA: Oh dear. 

SM: And it’s not written down. So, so, you know, the implication, the inference in her deposition was ‘I was doing what the physician told me to do.’ And of course, he says that didn’t happen. And, you know, I mean, the odd thing is these depositions happen years after the fact. They probably both believe it. I mean, in an emergency room, unfortunately, stuff like this happens all the time. 

You know, you have catastrophic, you know, we might think like someone who works in primary care might think, “I would never forget if something like this happened.” Because an anaphylactic-related death happening in a primary care office, I mean yeah, once in a career is too much, you know, so something like that might matter. Might not matter, but it might. 

You might remember it. But in the emergency room, those sorts of things do happen. Unfortunately, it’s the nature of the beast. And so you can totally see how three years later somebody has no recollection at all, at all, of being consulted on, on a particular patient issue, whereas the APRN really might have consulted with him, but it wasn’t written down. 

Nowhere. And I, and again, you know, I’m a realist. I know that some people listening are going, look, you know, we don’t have time to write down all this stuff. I know, but you do have time to write. If you can document epinephrine administered, you can write ‘reviewed with Doc X epinephrine administered at direction.’ 

JA: Right. And being that long, you know, from like when the event happened to, to the actual deposition in this case coming forward, documentation then isn’t even so much for somebody else. It’s also for you because I can’t remember what I did last week, you know, so let alone three years ago, like documentation is really for you too, just in case. 

Like, you can go back and see your notes and you can go back and see clearly, like what you did and didn’t do, because how, how in the world would you ever remember that. 

SM: You, you can’t. There’s no way. I mean, even, you know, even in my, in my primary care practices, my patients, I apologize for making them sit there while I finished writing my note, but I don’t let them out. So, my note. So, there’s enough there. I mean, I might, I might, you know, tie up the loose end at the end, but I don’t even let them out of the room or off the Zoom until after the bulk of my note is written. 

Because I’ve been doing this for so long because, like I said, I write every note as if somebody is going to be looking at it three years from now, trying, you know, just looking for exactly what happened and what I might have missed. I write my note like everybody’s going to try to sue me. 

JA: Yeah. I mean, it’s probably good advice. Wow. Dr. Miller, what are your big takeaways from this? I mean, I know for me, documentation. Holy moly, that’s super important. So much time has gone by. It seems like it was a clear presentation, but again, in bringing it back to documentation, it’s really hard to tell, and piece together what the story is. 

But what are the big takeaways for our listeners? 

SM: Well, I mean, some of the documentation is a big one, but I also think even though the documentation and timing is it’s hard to put it together, I, I do think it’s clear that we have this man who comes in with a history of an anaphylactic reaction, a known, documented history at that facility of anaphylaxis to this allergen. 

And he comes in saying, “This is how I felt the last time it happened.” So right there you know, safety first. I mean, Maslow’s hierarchy: safety first. If you have the remotest inclination that anaphylaxis is an evolution, give epinephrine now, ask questions later. You know, there’s absolutely no contraindication. Give epinephrine now and then worry about the, you know, the rest of the steroids and all that kind of stuff. 

And then, and, you know, epinephrine, if the patient’s condition doesn’t improve, you repeat it. I mean, for, for an anaphylactic reaction like 5 to 15 minutes, give it again. And if it still doesn’t, if the patient doesn’t improve, then it is time to escalate that care. You know, then it’s time to talk about, not just a walk by. 

‘Oh, Doc so-and-so, what do you think?’ Then it’s time to escalate that care to airway protection. I mean, that’s the, you know, the really sad thing here is that had his airway been protected in time, had he been intubated before he became so swollen, it would have, it would have likely been a different outcome. And there is some suggestion and over an hour before he goes to the ER that he’s having progressive symptoms, that there is marked swelling, that there is muffling of the voice. 

You know, in retrospect, that’s the time to intubate the patient or or at least give another dose of epinephrine.  
 
JA: Yeah.  
 
SM: So, we don’t know. We don’t know all the details. We can’t fine tune the particulars of the progression. But we can see that he sat there. He appeared to sit there for like an, at least two hours and at least nothing acute happened to the extent that it got anybody’s attention. 

But then we do know that there is objective evidence of posterior pharyngeal swelling, a muffling voice, a history of anaphylaxis. And even with all of that documented, there’s no further administration of anything or a move to the ER for another hour. 

JA: Wow. That is, that is, that is really unfortunate. But, but a powerful story and a powerful reminder for us all. Thank you, Dr. Miller, so much for sharing this with us. We hope that you enjoyed listening, but you learned something from this particular case and that, you know, you do find this helpful. A reminder, it’s certainly a helpful reminder for me, you know, these important pieces that we just can’t forget. 

Right. And the important practice pieces that we have to make sure that we can’t forget because unfortunately in this story, this was a really bad outcome. And that is sad to hear. And if you found this helpful, please check out some more of our podcast episodes that we have on FHEA.com. Goodbye for now. 

Voiceover: Thank you for listening and learning with Scrubs and Subpoenas: Tales from the Witness Stand presented by Fitzgerald Health Education Associates. Please rate, review, and subscribe to this podcast. And for more NP resources, visit FHEA.com. Join us again next time as we dissect more medical malpractice cases.