Reliance on high-tech and high-turnover leading to lawsuits in ‘hospitalist’-heavy San Antonio

In a recent malpractice lawsuit filed in Bexar County, attorneys say one IPC hospitalist was potentially responsible for up to 43 patients on the night he allegedly ordered a fatal dose of Dilaudid for a patient at North Central Baptist Hospital. Neither IPC officials nor the attorney representing the company in this case returned calls seeking comment. The Baptist hospital — no longer a defendant in the suit — did not return calls, either.

Business-friendly Texas is the largest market for the North Hollywood, California-based company IPC. A full 23 percent of IPC’s operations are here. In a 2005 press release, IPC said its hospitalists attended to at least 88,000 patients annually in Bexar County. It serves about 14 local hospitals, including those in the Methodist and Baptist systems.

Carlotte K. Watson, 57, died on March 23, 2008, while recovering from an amputation surgery. IPC hospitalists were assigned to manage her care in shifts and coordinate communications with the surgeon who amputated her left foot, attorneys said. According to the lawsuit filed in the 73rd Judicial District Court, IPC hospitalist Dr. Jesus Virlar never consulted with the surgeon before prescribing Dilaudid, the synthetic opiate, which was the drug of choice for Matt Dillon’s Drugstore Cowboy character.

Watson’s surgeon authorized other pain meds, but Dilaudid was not one of them. He later said in a deposition that Dilaudid was not on the list because it was too dangerous considering Watson’s history of diabetes and hypertension. The hospitalist, working from home at the time, instructed a nurse to administer Dilaudid after Watson complained of pain, according to the lawsuit. Soon after the medication was administered, Watson’s heart rate fell rapidly and she went into cardiac arrest. She died at the hospital less than two days after the incident.

According to the suit, medical records showed Dr. Virlar did not review Watson’s medical chart, visit with her, or consult the surgeon before ordering Dilaudid. “Rather than come to the hospital to have access to patients’ charts and the patients themselves, Dr. Virlar chose to stay at home and play telephone doctor,” the lawsuit states.

IPC hospitalists never made rounds to visit Watson during the first day she was in hospital recovering from surgery, either, according to the lawsuit.

“Ten years ago, hospitalists didn’t really exist,” said Tom Rhodes, a San Antonio lawyer representing Watson’s husband, David. “This is the new world we live in. Now hospitalists are expected to manage 50 patients per shift, and they’re not always looking at medical records.”

Another IPC hospitalist, Dr. Dominic Meza, stated the cause of death was “coronary artery disease,” according to the lawsuit. Watson, however, had never been diagnosed with such a condition prior to her admission to North Central. Her husband, David, learned months later that the Bexar County Medical Examiner ruled “narcotic intoxication” was the cause of death, according to the lawsuit. “The medical examiner subpoenaed all the medical records and learned she had two heavy doses of Dilaudid,” David Watson said. “People need to be well-informed about who’s treating their loved ones. You never imagine a doctor will be sitting at home prescribing drugs like that.”

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