Did a Georgia surgeon violate the standard of care by his decision not to immediately operate on a patient who later died? Or was his decision the right one, given not only her condition but also the lack of resources at the hospital near Fort Stewart?
Surgeon Stephen Weiss had not met the standard, according to the Marietta physician who reviewed the case for the Georgia Composite Medical Board. He should have had sufficient information to conclude that the patient was in septic shock and immediate exploratory surgery was necessary. The board decided to sanction Weiss, also pointing to transcripts of testimony by other physicians who were witnesses for the woman's family in a malpractice lawsuit.
But Weiss took his case to the Office of State Administrative Hearings. After hearing from two other doctors who reviewed the case on Weiss' behalf, it rejected the board's recommendation. OSAH cited not only the woman's weakened condition, but the lack of resources at the Hinesville medical center where the woman was hospitalized.
The woman, referred to in court documents as A.R., had had surgery less than three weeks earlier, then returned to the medical center with abdominal pain, unable to urinate. Weiss considered transferring her to a Savannah hospital, as her condition deteriorated, but decided she was too unstable. Weak as she was, he also decided to start more antibiotics, hydrate her and consider operating the next morning.
That doesn't amount to a failure to meet minimum standards of medical care, administrative law Judge Michael Malihi concluded.
"After assessing the resources available to him at Liberty Regional, Respondent determined that performing surgery on A.R. at Liberty Regional would not be the best course of action," the decision says. "As a critical access hospital, Liberty Regional lacked an intensive care unit or any critical care facilities. Moreover, no physician anesthesiologist, cardiologist, critical care pulmonologist, or intensivist was on duty at Liberty Regional to assist with surgery."
The judge also said that the testimony of witnesses at the hearing carried far greater weight than the transcripts submitted by the board for the experts who had testified in the malpractice case. The board, the judge wrote in his March 20 decision, had not carried its burden of proof, so no sanctions should be imposed.
The decision had no further information on the malpractice litigation. Weiss' profile on the medical board's website shows no court malpractice judgments. It lists a $1.25 million settlement made in May 2011, but there's no information about what case that settlement may concern.