Home / Patient Encounters / The Case of the Bleeding Ear Takes a Bizarre Twist

The Case of the Bleeding Ear Takes a Bizarre Twist

By Birdstrike M.D.

My shift is over and I’m ready to head out the Emergency Department door.  When I walked in 12 hours ago, the department had 20 waiting patients.  I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds.  My partner Dr. Jim looks at me and says, “Get out of here.  Don’t even think about staying late.  You can’t save the world.”  With me leaving, the department will drop to single coverage with Jim taking the reins alone the rest of the night.  Despite his words, the dejected look on his face reads, Help! It’s going to be a long and grueling overnight shift for Dr. Jim.

I look up at the monitor and it says, “Ruptured eardrum.”  That’s easy, I think to myself.  I’ll stay late and see at least one more patient to help out.  I walk in the room and it’s a 16-year-old girl, in a green and white basketball uniform, with her mom and dad, who looks like he could be a retired football linebacker.  “I got hit in the ear with the ball.  I can’t hear at all, and my ear’s bleeding.  This is the second time, it’s happened.  Last time I couldn’t play basketball for a week,” she says.

“Okay, let’s take a look,” I say.  I put a couple of drops of peroxide in the ear to soften up the dried blood.  Hmm?  There are no bubbles.  I clean out the ear and…what is that smell?  Do I smell raspberry jelly?  I clean out the ear more and look at the ear drum.  It’s perfect.  There’s no rupture and no laceration in the canal.  Her ear is completely normal.

“I won’t be able to play this weekend, will I?” she asks.  “Just put me on the injured list this weekend, and we’re good to go,” she says with a bubbly smile.  Being that she’s 16, and still a minor I ask her parents if she and I can talk in private for a minute.  They say okay, I have a female nurse come with me, and we close the door.  “Did you put something in your ear?” I ask.  “Like raspberry jelly or something, to make it look like blood?”

“Yes,” she says, looking deflated.  She then confesses that she doesn’t want to go to the tournament and concocted the whole story to have a reason to be injured, so she could go to her boyfriend’s party, instead.  I thank her for her honesty.  “Can I go now?” she asks.

I discharge her and on the way out the dad comes back in, “Doc, she faked it didn’t she?  I know she doesn’t want to play in the tournament.”  Without speaking, I gave a half nod.  He smiled and walked out.  Even though I was dog-tired after working 12 1/2 hours and staying late, I finished the shift a little lighter, with a simple case where no one died, no one bled out, or inappropriately demanded narcotics.

A week later prior to a shift, our ED director Dr. Bob comes to me and says, “Hey Bird, how’ve you been?  I’ve got some good news, bad news and ugly news.  Which do you want first?”

“None of it,” I answer.

“Okay, the good news.”  Then, with the phrase no ER physician ever wants to hear, “Remember that kid you saw last week?  The one with the bleeding ear?”

“No.  Wait, do you mean the one with raspberry jelly coming out of the ear?” I chuckle.

“Yeah, that one.  Well, she’s alive,” he continues.

“I figured that.  I haven’t seen death by raspberry jelly, yet,” I laugh.  Then he drops this on me, “The bad news is she attempted suicide the night after you discharged her.”

“Wow, that’s terrible.  There was no sign of that at all.  It was just a simple ear complaint.  What’s the ‘ugly’ news?” I ask, half not wanting to know.

“The ‘ugly’ news is that it’s your fault; at least according to the girl’s father,” says Director Bob.

“What?” I exclaim half-shocked, half-knowing I should never be shocked by anything that happens in or around the circus that is the “Emergency Department.”

“Yeah, I know.  No good deed goes unpunished.  Plus, they filled out a Press-Ganey survey, giving you the lowest scores possible then filled a formal complaint with administration,” says Director Bob, acting irritated at me.  “Now it’s my job to smooth this crap over, somehow.”

“A complaint about what?” I ask.

“Well, they’re claiming you violated EMTALA, and committed malpractice by missing the diagnosis,” says Director Bob.

“What?  She got a screening exam and there was no inkling of depression whatsoever.  That’s a crock of #&@$%,” I say, in disbelief.

“Maybe, but administration is very concerned, plus they are worried there may be a HIPAA violation, also.  You know contract renegotiations are coming up soon.  They’ve been holding the blow torch to my back over metrics, and now this.  Let’s just say they’ve made some threats,” says Bob.

“What diagnosis are they saying I missed?  The kid put jelly in her ear for Pete’s sake.  And HIPPA, I didn’t violate HIPAA?  First of all, she’s a minor, plus I didn’t tell the father anything,” I say exasperated.

“Let me see,” Director Bob says dropping his glasses, looking down at his notes.  “You may have violated HIPAA by telling the father the girl faked the injury, when that was supposed to be a private conversation between you and the girl. Then when he confronted her, and told her she couldn’t go to some party, then she goes and swallows a handful of his pain pills and overdoses.  The missed diagnosis was suicidal depression, and you violated EMTALA by not doing a proper medical screening exam, specifically, a psychological screening exam.  I’m quoting the complaint now, ‘THE DOCTOR IS 100% RESPONSIBLE FOR THIS.’”

“You’ve got to be kidding me?” I ask.

“Unfortunately I’m not.  Now, for the bad news,” he continues.

“Wait a minute, that was the ‘good’ news?  Whatever, just tell me,” I say.

“They plan to contact an attorney and are threatening to sue you, the hospital, and the group,” he says.

“Of course.  This is utterly nauseating and ridiculous.  I don’t have time for this, I have to go start my shift,” I answer, more than ready to be done with this conversation.

“Make sure you draw up a draft apology letter for me, so I can send that out to the family.  Admin requires it, you know,” says Director Bob.

“Apology, for what?  You’ve got to be kidding me,” I say.

“No, I’m not, but don’t worry about it,” says Director Bob, in a nervous hurry.  “You know how the system works.  It’s just business, Bird.  Just get back out there, keep cranking those patients through the department as fast as possible, keep the Press-Ganey scores up and everything will be…just…fine.”

 

 

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This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information about real patients. To the extent that any post is based on the real life experiences of the author, names, dates, ages, sexes, locations, diagnoses, and all other factual information are routinely changed to the extent that they are fictional, and certainly HIPAA compliant. Any opinions expressed here are of the author alone and not those of Dr. WhiteCoat, my employer or any of the hospitals with which I am affiliated.

 

7 comments

  1. As an HR professional, I’m used to dealing with all sorts of “interesting” behaviors and situations but your description of the results of a self-concocted “injury” and subsequent events is the most bizarre, idiotic, and sad stories I’ve heard in a long time.

    Obviously, this child’s parent didn’t want to do the responsible thing and check her ear out BEFORE taking her to the ED. How could anyone miss the smell of rasberry jam? The father obviously, again, didn’t want to stand up to his daughter and say “no, you are not injured. Yes you are going to play and support your teammates and NO you are not going to the party”. He had to involve a third party which meant an expensive trip to the ED. Bet if this wasn’t covered by insurance, this never would have happened! Hope you have a good lawyer who can write a nice apology letter saying you are so glad her ear wasn’t really injured since good hearing is soooo very important in life and you are very sorry to hear she felt so upset after her dad forbade her to go to the party she wanted to go to that she tried to take her life and you sincerely hope that she will get the help she needs!

  2. I’m sorry to hear that… Sometime people just looking to blame the one person who has done nothing wrong…

  3. This is why I don’t understand why we can’t countersue for emotional trauma and defamation of character.

  4. And people ask me why I stopped doing patient care.

    You can have 100 wonderful experiences, feel you’re making a difference, but just one like this when your livelihood and reputation are at stake, is enough to outweigh the positives.

  5. Unfortunately I’ve been to the ED. The drs are wonderful if you are
    Nice and cooperative. I have a complex issue and recently had complications. I showed up with a lust of my drs, meds, surgeries, films, reports, etc. the Er doc was awesome. Show up with raspberry jelly, not much can be done. The Er doc I saw would never in a million know if I was suicidal while trying to deal with what actually was an emergent situation. Er docs have an already difficult job and people have $$$$ signs in their eyes. Keep on keepin on.

  6. F#CK THEM.

    And the drama queen kid.

    There’s a whole boat load of crazy in that family.

    This isn’t their first time at the crisis mental health rodeo. (trust)

    Pity the poor shrink that has sort them out.

    We are perfect.

    My kid has the issue.

    Can’t you wave your magic wand and make it all better?

    You’ll see it again when she ODs on the Zoloft and Klonopin she gets from her shrink.

  7. This is completely and utterly disgusting. Please let us know how it all works out.

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