TMB rules you may not know but should, part 1; CRNAs and the anesthesia care team model (CME);
Failure to diagnose pneumonia; Failure to conduct pre-operative evaluation

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Failure to diagnose cornual pregnancy
A 33-year-old woman came to the emergency department (ED) complaining of bilateral abdominal pain, back pain, and shortness of breath.
Failure to insist on EMS transport
At 8:30 a.m., a patient’s wife called her husband’s family physician and requested an appointment because her husband was experiencing chest pain that began the previous evening.
Failure to diagnose rhabdomyolysis
At 3:20 p.m., a 3-year-old girl was brought to the emergency department (ED) with complaints of fever, lethargy, sore throat, severe leg pain bilaterally with decreased sensation, and absent reflexes.
Failure to monitor patient’s postoperative INR
A 54-year-old woman came to an orthopedic surgeon with complaints of chronic bilateral hip pain lasting for 30 years.
Failure to properly supervise
A 28-year-old woman came to an orthopedic clinic with right hip pain lasting for two weeks. Orthopedist A’s physician’s assistant (PA) examined the patient and obtained x-rays.
Failure to evaluate patient
A 72-year-old man was evaluated by Ophthalmologist A on several occasions. The patient had cataracts, with best corrected visual acuity of 20/25 in the right eye and 20/40 in the left eye.
Negligence in placing incorrect lens
A 59-year-old man came to his ophthalmologist complaining of ongoing visual problems. He had a long, complicated history that included uveitis, inflammation, and glaucoma.
Improper performance — cataract surgery
A 63-year-old man came to Ophthalmologist A complaining of visual changes to both eyes. He had a history of bilateral cataracts.
Failure to properly perform surgery
A 45-year-old woman came to her ob-gyn for complaints of heavy bleeding and pelvic pain. The patient’s history included pelvic inflammatory disease, a bilateral tubal ligation, and myomectomy.
Failure to discontinue medication
A 34-year-old woman came to an ob-gyn for prenatal care on May 25. This was the patient’s fifth pregnancy.
Failure to diagnose breast cancer
A 49-year-old African-American woman came to an internal medicine physician in August 2001. She continued to see this physician and his physician’s assistant for several years.
Failure to order appropriate treatment
On December 3, a 27-year-old woman came to the office of Internist A. The patient reported abdominal pain.
Failure to diagnose and treat thrombosis
A 66-year-old man came to his internist with complaints of shortness of breath and chest pain that had been present for three to four weeks.
Failure to properly manage resuscitation efforts
An 8-year-old girl with a history of a congenital bicuspid aortic valve and aortic stenosis was in need of restorative dental work for dental decay/cavities.
Failure to order chest x-ray
A 68-year-old woman residing at an assisted living facility was having syncopal episodes that resulted in falls with minor head trauma.
Vision loss following surgery
A 41-year-old woman was referred to an orthopedic surgeon. She had a history of progressive lumbar scoliosis secondary to spasticity from congenital diastematomyelia.
Failure to monitor patient during stress test
A woman in her early 60s was referred to a cardiologist for chest pain and dyspnea on exertion. The patient reported a history of hypertension, high cholesterol, and diabetes.
Procedure performed when contraindicated
A 67-year-old man was referred by his primary care physician to a gastroenterologist for a routine screening colonoscopy.

Reporter 2015 General Surgery
Wrong site surgery; Dos and don'ts of renewing Your Texas Medical License

The Reporter Volume 3 2015