Florida – Family Medicine – Weakness Of The Left Hand And Slurred Speech For Three Weeks

On 8/14/2014, a 54-year-old male presented to an urgent care clinic with complaints of weakness in his hands and slurred speech for three weeks.

The patient was initially seen by a triage nurse who noted weakness in the left hand, affected speech, and feeling “stroke-like symptoms.”

The patient’s checklist listed “stroke symptoms” as a concern to be addressed by the family practitioner.

The family practitioner reportedly did a complete neurological exam of the patient with the family practitioner noting weakness as the only finding.

There was a later note by the family practitioner that the neurological exam was normal.

The family practitioner diagnosed the patient with a transient ischemic attack (“TIA”).

The family practitioner also diagnosed the patient with an allergic reaction and increased blood pressure.

The family practitioner treated the patient for the allergic reaction and increased blood pressure but never treated the patient for the TIA.

The next morning, the patient went to an emergency room due to inability to walk.

The patient was diagnosed with a massive cerebral infarction.

The patient became severely incapacitated and had to reside at an assisted living facility.

The Medical Board of Florida judged the family practitioner’s conduct to be below the minimal standard of competence given that he failed to treat the TIA and/or make an urgent referral to a facility for further evaluation including neuroimaging, cervical cephalic vasculature imaging, cardiac evaluation, statin medication, and blood pressure management.

It was requested that the Medical Board of Florida order one or more of the following penalties for the family practitioner: permanent revocation or suspension of his license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, probation, corrective action, payment of fees, remedial education, and/or any other relief that the Medical Board of Florida deemed appropriate.

State: Florida

Date: February 2017

Specialty: Family Medicine, Internal Medicine

Symptom: Weakness/Fatigue

Diagnosis: Ischemic Stroke

Medical Error: Underestimation of likelihood or severity, Referral failure to hospital or specialist

Significant Outcome: Permanent Loss Of Functional Status Or Organ

Case Rating: 3

Link to Original Case File: Download PDF

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