[Noah930]

For malpractice, you have to demonstrate gross negligence. While you may have objected to the CT scan and preferred a cheaper ultrasound, the CT scan was not an inappropriate test given what you present of your wife's symptoms. Additionally, different specialists are held to different standards. So an NP working in the ER is not held to the same performance standard as a general surgeon or gynecologist. The NP may have had the wrong working diagnosis (and you can be rightfully mad at that), but that's why the surgeon was called in. And BTW, no surgeon is going to operate based upon what an NP tells him/her to do. No surgeon is going to operate based upon what an ER doc tells him/her to do. No surgeon is going to operate solely based upon what a radiologist tells him/her (which is why the surgeon went to see the CT scan for himself). BTW, fat stranding around the appendix can be an early indicator of appendicitis, and is one of the signs of appendicitis looked for in an ultrasound.

That the CT scan was apparently misread by the radiologist is a separate matter. But that brings us to a different question: who ya gonna sue? Shotgun approach (a.k.a. everybody)? Or is your ire directed specifically at the nurse practitioner? Or the radiologist? Or the CT tech? Doesn't seem like the general surgeon did anything wrong. Arguably, the NP didn't do anything wrong. The NP may have had the wrong working diagnosis, but did not order an inappropriate test given what you've told us. And while the NP may have had the intent to operate, the NP doesn't have the authority/privilege to operate. Heck, the ER NP doesn't even really have the privilege/responsibility to obtain surgical consent from your wife. Which is where the surgical consultation comes in.

I understand you're upset. You're mad at the cost of the test. You're mad that the NP didn't "listen to you." You're mad at the radiation exposure (which is generally held to be negligible from a medicolegal perspective). But that doesn't mean the care you received fell under "gross negligence." The only exception may be the radiologist's reading. Would be interesting to see if there's any "correction" in the final report. Of course, there's probably some legal disclaimer that the reading is "preliminary" and is not final until the dictation transcription is read, reviewed, and signed by the radiologist.

I wasn't there, but: Periumbilical pain can be an early sign of appendicitis. Nausea, vomiting, and bowel habit changes are not commonly associated with appendicitis. Admittedly there's usually some sort of elevated white blood cell count on bloodwork. I don't know what the physical exam was like; that, and the "look" of the patient count for a lot in forming a differential diagnosis. But it's not unrealistic to obtain a CT scan in that setting. In fact, I'd opine that there will be far more CT scans obtained in an ER setting than ultrasounds. Some of that is due to logistical and/or staffing issues. Some of that is honestly medically-related. But, again, the CT scan is more likely going to be considered the standard of care than the ultrasound.

One final random thought: traditionally it is (unofficially) taught general surgeons that there should be a 10% negative appy rate. That means 10% of appendectomies are done ... on normal appendices. If your rate of false appys is lower than that, you're not aggressive enough of a surgeon; you're going to sit on too many patients you should have operated on (at least at an earlier and more favorable time in their disease state). If your rate is higher than that, you're too aggressive. Interestingly, even with the advent of all these fancy-schmancy tests, the false appy rate hasn't changed too much over the years. And even if an appendix looks normal at time of surgery, it gets taken out anyway as SOP.

Best of luck to your wife with her cyst.