Medical-Legal Triage Case Study: Salmonella

A middle-aged woman goes to a barbecue where she eats something tainted with salmonella. She ends up going into renal failure, but recovers without much damage beyond her few days of hospitalization and the associated pain and suffering. The defense attorney wants an examination by a gastroenterologist in Widget County, PA.

So, what’s the problem with just providing what was requested?

Pretty much everything. First, a gastroenterologist is not the best choice. Although food poisoning cases typically raise issues in either gastroenterology, infectious diseases, or microbiology, this case differs. While a gastroenterologist could talk about the pain and suffering of food poisoning, an ID or a microbiologist might be better if issues of salmonella etiology or scientifically possible incubation period are involved or there were questions about the efficacy of treatment provided. Again, this case differs.

So, who should review it?

Nephrology is the medical specialty that treats kidneys. This includes kidney diseases, diabetic complications (as kidneys are subject to small vessel disease complications of diabetes), congenital kidney problems (more commonly those will end up with a pediatric nephrologist), and even autoimmune and (medical) kidney transplant issues. The questions in this case surround the renal damages so, absent a compelling reason otherwise, that would be best.

What about the exam?

That’s the second problem. There is no need for an exam. Exams on the defense side fall into three categories: needed, not needed, and not-really-needed-but-one-should-be-done-to-make-the-eventual-witness-not-seem-like-s/he-hasn’t-looked-at-everything. This last category is really: “it’s not necessary, but the jury won’t understand what is necessary, so do one anyway.” That said, a nephrologist (or any other doctor) wouldn’t get any relevant information (beyond history) so an exam is really not in the needed category. Frankly, an examining physician can’t say “turn your back to me so i can cut you open and touch your kidney.” Again, even if an exam was needed, a nephrology expert–not a gastroenterology expert is the right choice. The evaluation of this case is completely based on the paper; the patient (meaning for an exam) is not needed. Again, this does not address the category “not-really-needed . . ..”

And the lesson?

Think very carefully about why an exam is being done (because sometimes it really is not needed) and think even more carefully about which expert is really the correct one.