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Pediatric emergency medicine: legal briefs.

A 19-year-old boy was herding cattle on a California ranch in July 2010 when he suddenly slumped over and had difficulty speaking.1 The boy's father immediately drove him to a nearby emergency department (ED). The teenager was triaged in the ED about 1 hour after the onset of his symptoms, and the ED nurse recorded in her note that the boy was possibly having a stroke. The emergency physician noted that the teenager was flaccid in all 4 extremities and was unable to speak. She then ordered a noncontrast computed tomography (CT) scan of the brain, which was read by a radiologist as showing a small infarct of indeterminate age in the left thalamus. A complete blood count, electrolytes, and glucose levels were all normal. A toxicology screen was also negative. At midnight (several hours after presentation), the emergency physician called the on-call hospitalist (a pulmonologist) to transfer responsibility for the patient. The hospitalist was covering the hospital from home on this night shift. He admitted the patient to the hospital without personally examining the boy. The hospitalist believed that a neurology consult had been obtained, and therefore he decided not to go to the hospital to evaluate the patient himself. He did not request an emergency neurology consult. During the night, the teenager's symptoms waxed and waned such that he had a normal score on the GlasgowComa Scale, and he regained the ability to move 1 side of his body. Around 8 AM, the next morning, however, the patient's neurological condition deteriorated. He became obtunded, and he aspirated. Angiography was obtained, and this revealed that the basilar artery was occluded. A stroke