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Exeter Hospital doctor agrees to reprimand in patient death

New Hampshire Union Leader

May 09. 2018 10:48AM
EXETER HOSPITAL (Union Leader File Photo)

An Exeter Hospital physician has agreed to an official reprimand from state medical authorities after an emergency-room patient he examined died from complications related to an infected kidney stone.

Dr. Craig MacLean, a doctor of 14 years in New Hampshire, acknowledged that the state Board of Medicine could determine he engaged in professional misconduct if the case went to a hearing.

An eight-page settlement agreement paints the picture of a physician who did not make a complete review of triage notes, which detail the initial nurse interviews with a patient.

And he lumped inquiries about multiple symptoms into a single question.

For example, MacLean said he was unaware that the patient — a 67-year-old woman — had a fever of 101.5 degrees the previous day. The patient had reported the fever to the emergency-room nurse.

“(MacLean) explained that he did not recognize the need to scroll down on the computer screen to view the portion of the triage note referencing the fever,” the settlement agreement reads.

MacLean saw the patient on Oct. 24, 2016. She reported a history of kidney stones, the fever and significant pain and discomfort. But MacLean’s notes say no fevers, chills, abdominal pain, swollen joints or sore throat were noted.

When he spoke to the patient, he framed all the symptoms into a single question; the patient addressed vomiting first; MacLean did not return and ask about other symptoms.

After limited tests and a consultation with a urologist, MacLean sent the patient home with painkillers, believing she suffered from inflammation but not an infection.

Two days later, she returned weak, vomiting and with diarrhea. She was admitted to the hospital with acute kidney failure, sepsis and acute kidney infection.

She died the following day.

A medical malpractice lawsuit was filed against MacLean the following year, which launched the Board of Medicine investigation.

MacLean said he now reviews triage notes in a new visual format that displays the entire triage information in a single page.

He also asks individual questions about fever, chills, nausea and vomiting. Finally, he has added a “discharge time out” to his practice, which allows greater deliberation on discharge decisions.

As part of the agreement, MacLean must also take eight hours of education focusing on the diagnosis and treatment of kidney stones, patient safety and medical mistakes.

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