The patient was a 77-year-old man with a history of paroxysmal atrial fibrillation, hypertension, hypothyroidism, depression, osteopenia, and Parkinson’s disease, who had been previously treated by an internist at his prior practice.
On 04/25/2014, the patient reestablished care with the internist, who performed a wellness visit. Labs completed the prior week showed a platelet count of 1,105,000 and further commented that there were 1+ giant platelets and 1+ large platelets.
The physician documented that the labs were reviewed with the patient, but there was no documentation that the physician addressed the patient’s elevated platelet count.
On 06/20/2014, the patient presented to the emergency department with fatigue and tiredness. He was found to have a hemoglobin of 5.3, hematocrit of 16.7, platelet count of 1155K, and WBC of 16K. The admitting physician noted that the patient’s prior CBC also showed a platelet count of 1105K. The patient reported that he had never seen a hematologist or oncologist. The patient was evaluated by both a GI consultant and hematologist who diagnosed the patient with iron deficiency and reactive thrombocytosis. The patient was also subsequently diagnosed with myelodysplasia.
The Board judged the internist’s conduct to be below the minimum standard of competence given failure to manage the elevated platelet count level in a timely manner.
On 04/2016, an interim order was issued for the internist to complete a competency evaluation. The internist appealed. On 08/04/2016, the Board denied the internist’s appeal of the interim order. The provider submitted his intention to retire. Given concern that the internist had also performed below the standard of care in a multitude of cases, the Board elected to restrict his practice and prohibited from practicing medicine in the state of Arizona. They ordered that he complete and pass a competency evaluation in order to reverse the practice restriction.
Date: January 2017
Specialty: Internal Medicine
Diagnosis: Hematological Disease
Medical Error: Failure to follow up
Significant Outcome: N/A
Case Rating: 3
Link to Original Case File: Download PDF
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