1). Describe the four components (Act, Duty, Breach, and Damages) of the medical malpractice for your case.

2). Can you identify when the standard of care deviated?

Jury awards $1.4 million verdict against Philadelphia nurse practitioner who failed to treat hyperthyroidism

Key Takeaways

• Michael Woodall's primary care provider, a nurse practitioner, did not change his treatment after bloodwork showed severely high thyroid hormone levels.
• Woodward's estate alleges that Woodward was not notified about his thyroid levels or educated about his condition.
• The lawsuit against the NP names the medical center and supervising physician.

Recently, appeals and proceedings concluded on a jury trial out of Philadelphia. On June 4, 2021, A unanimous jury verdict awarded a plaintiff just over $1.4 million as part of a medical malpractice case against a nurse practitioner who allegedly failed to properly treat a case of severe hyperthyroidism, leading to the death of a patient.^[1]

In 2015, Micheal Woodall visited his primary care physician and nurse practitioner, Sagine Bien-Aime, CRNP, at Excel Medical Center in Philadelphia for a check-up for asthma. While in the office, Bien-Aime and the treating physician noticed a swollen area on his neck. Woodall had blood drawn and was given a prescription for thyroid medication.

At a follow-up appointment four days later, Woodall was told that his blood work confirmed hyperthyroidism. He was instructed to continue his medication and to return for another follow-up in 6 weeks. Five months later, Woodall returned to Excel Medical Center with a still-swollen neck, and his blood was drawn again. Records indicate that the blood work revealed severe thyroid levels, but Woodall was not notified of these findings. There were also no changes to his treatment at this time.^[1]

When Woodall returned to Excel the following month, he was seen by a different physiciannot included in the lawsuitwho was extremely concerned about Woodall's thyroid levels. The physician increased Woodall's medication dosage and advised both a thyroid ultrasound and an endocrinologist visit as soon as possible.^[1]

In May 2016, about 10 days after his appointment with the new physician, Woodall was visiting with his family when he began experiencing nausea, vomiting, and weakness. He was transported by ambulance to a nearby hospital but died on arrival. Woodall was only 30 years old.^[2][1]

Woodall's wife, Asia Woodall, filed suit against Bien-Aime, Excel Medical Center, and additional medical providers at Excel, including physician John Michael, DO, MBA, alleging that her husband's death was caused by the defendants' failure to diagnose and treat him properly. The suit claims that Woodall attended four appointments with the defendants and that despite his symptoms not improving and his blood work showing his condition worsening, they failed to inform him of the seriousness of his condition and to change his treatment.

The defense denied these allegations, arguing that Bien-Aime could not be blamed for Woodall's death. Additionally, the defense claimed that Woodall was negligent in causing his own death.^[2]

The jury disagreed. After a 2-week trial, the jury ruled in favor of the plaintiff, stating that it found no fault on the part of Woodall. The Woodall family was awarded just over $1.43 million.^[2]

Medical malpractice suits against nurse practitioners and physician assistants

Asia Woodall's malpractice suit named a physician at Excel Medical Center, Dr. Michael, despite Bien-Aime being Woodall's primary care provider. This isn't uncommon for medical malpractice suits against nurse practitioners and physician assistants. Often, physicians are found liable for the NPs and PAs they supervise or employ, no matter how directly they were involved in the care at the center of a specific malpractice case.

Exactly how much legal responsibility a physician has for these professionals varies state by state and across different settings. For instance, in some states, NPs are only permitted to practice under the direct supervision of a physician, while 27 states grant NPs full practice authority. This independence has been growing over the past several years, especially since the passage of the Affordable Care Act. Between 2011 and 2016, 82% of all malpractice claims against NPs also mentioned the supervising physician. However, the average liability NPs incurred in lawsuits rose 10.5% between 2017 and 2022, and as restrictions on the scope of NP practice have lessened, the number of payments physicians have made in cases against NPs has decreased by 31%.^[3][4]

Of course, multiple states, including California and Texas, still place strict restrictions on NP practice. Physicians in those states are more likely to be considered liable for malpractice cases brought against NPs. Restrictions for PAs are similarly varied and are changing across the country as PAs continue to gain autonomy and an increased scope of practice.

No matter the exact regulations and laws regarding autonomy and liability in your state, the American Medical Association (AMA) recommends that physicians always take the lead and bear ultimate responsibility for patient care. In a statement, the AMA noted that:^[5]

"Physicians should bear ultimate responsibility for coordinating and managing patient care, with appropriate input from physician assistants...The American Medical Association encourages physician-led healthcare teams that utilize the unique knowledge and valuable contributions of all clinicians to enhance patient outcomes. Physician assistants and nurse practitioners are valuable members of this team, and patients win when each member of their healthcare team plays the role they are educated and trained to play."