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Paul Cirel helps medical doctor avoid discipline for treatment of patient in ‘close case’

Paul Cirel persuaded an administrative magistrate to rule that a medical doctor should not face professional discipline for his examination of a woman who died from streptococcus pneumonia a few days after the examination.

Following a three-day hearing at the Division of Administrative Law Appeals, the magistrate determined that the Board of Registration in Medicine failed to prove that the doctor’s treatment fell below the standard of care.

Characterizing  the underlying facts as a “close case,” the magistrate found the medical expert opinion supporting the doctor’s defense more persuasive than the conflicting expert testimony on behalf of the Board.

The explanation by the doctor’s expert “that it is possible for a patient to be infection-free one day, and then have an infection the next day, is the most reasonable explanation of what occurred,” the magistrate wrote.

In 2013, the doctor at an urgent care facility examined a 41-year-old woman who was experiencing a fever, rash, and diarrhea.  She also complained of having very cold upper and lower extremities and presented discolored skin in her toes, hands, and cheeks. 

The doctor diagnosed Raynaud’s disease – which is severely restricted blood flow to affected areas – and instructed the woman to seek further medical attention if her condition did not improve or worsened.

She passed away a few days later from streptococcus pneumonia. 

The medical expert who testified on behalf of the Board emphasized the fact that the woman had her spleen removed in 1993 because of a motor vehicle accident.  Because an absent spleen could increase the likelihood of an infection, the doctor should have tested for an infection, the expert testified.

However, the magistrate discounted this conclusion, finding that the expert failed to show that the prevailing standard of care requires testing for an infection solely because a patient is more susceptible, even if the information at time of an examination does not indicate an infection.

The magistrate found that the woman’s vital signs were normal but also had symptoms suggesting signs of an infection, along with the signs of Raynaud’s disease.  Considering this “bizarre” set of symptoms facing the doctor at the time of the examination, his treatment met the acceptable standard of care, the magistrate said.