Stephen Miley, M.D., FACEP

Case Descriptions

Standard of Care

 A 67 yo WF Hispanic was struck by a car, a low velocity parking garage MVA. She was seen in the ER by the PA. She complained about R hip pain and R knee pain. Plain film X-ray of the R hip and pelvis were read by the attending radiologist as “no fractures” and R knee had a proximal fibular fracture. She received a knee immobilizer and a walker and was told to follow up in 2-3 days with the orthopedic surgeon on call. She limped out of the ER with a friend. She did not see the referral physician and presented 11 days later with persistent hip pain. CT of the hip and pelvis showed a fracture of the interior and superior pubic rami. The superior ramus fracture extended, without displacement, into the acetabulum. The case was settled and resulted in a defense verdict in favor of the PA. 

Missed Diagnosis

 A 46 yo Hispanic WF was seen at a Level II Trauma Center for abdominal pain by the PA. CT scan revealed a segment of the sigmoid colon that was either diverticulitis or colitis. The PA did not treat her with antibiotics. She returned 11 days later to another hospital where a second CT of the abdomen revealed diverticulitis with perforation and an abscess requiring a long stay in the hospital and an eventual colostomy. The case was settled in favor of the patient/plaintiff. 

Missed Diagnosis of CVA

 A 68 yo WM presented to the ER with aphasia and a R hemiparesis. Last seen normal 2 hours prior as per his wife in the nurses notes. The ER physician did not read the nurses notes, or speak with the wife in the waiting room. The patient did not receive TPA or interventional thrombectomy. The case was settled in favor of the patient/plaintiff.

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