lifting the lid

It seems that there is a bit of a problem with frivolous lawsuits in Ireland at the moment. Advertisements on TV proclaiming trouble-free injury hotlines and ‘no win, no fee’ litigation are increasing, and seemingly in the hospitals (especially amongst the population at St Elsewhere) we are seeing the fallout of people in minor accidents attending hospital so they have a medical report documenting their ‘injuries’.

One such individual came in by Ambulance resplendent in all of the rescue and extraction gear. He was on a spinal immobilisation board and also cacooned in a ’KED’, which is a device used to extricate patients with spinal injuries from their cars. The history we had from the ambulance officers was, that he was involved in a very low speed accident in heavy traffic. The man in question was refusing to say much of…well…anything. He was extremely agitated encapsulated in the decidedly uncomfortable extrication gear, but nonetheless stated he had neck pain and was apparently unable to move any of his limbs. Of course, whilst I was looking at him, I was tracking through the list of possible injuries he may have and how we were going to investigate him most appropriately.

The ambulance officers took me aside and mentioned that the car had no real damage to speak of and that he had been walking around for over an hour after the accident before he decided to move his car to the side of the road and call the police and ambulance service. When they arrived he refused to move from his car and had to be extricated. Suddenly, my index of suspicion went down a notch or two.

We examined the patient and couldn’t find any injuries, or anything concerning about his physical state, aside from neck pain. Consequently we strapped him flat on his back with full immobilisation until we had some x-rays available. It was a busy day and I didn’t get back to him for a while. In the interim some Gardai (police officers) attended the department looking for our patient. As it turns out, he was involved in a ridiculously minor car accident. Annoyed that the Gardai hadn’t attended the scene he sat in his car and telephoned emergency services. Unfortunately for him (as it turned out) he refused to exit his car when the ambulance attended. Faced with a patient who couldn’t get out of his car, and a potential (although highly dubious) spinal injury, they were forced to call the fire brigade. It seemed that he sat in his car patiently as the fire brigade cut off the roof and doors of his car with the jaws of life so they could remove him safely.

Faced with this information and very normal neck x-rays we were very non-plussed with our patient who had, by this time, been lying on his back in the same position for 5hrs, developing back pain and even more baffling neurological injuries. This forced further imaging of his spine, all of which turned out to be normal.

Armed with this information we removed all the immobilisation equipment, told the man that everything was normal, he was fine and could leave. So, with an apparent miraculous recovery he thanked me, sat up in bed and walked out of the department with his wife. Walking back to the nurses station, I couldn’t help thinking that this man had destroyed his car, faked injury and stayed immobilised on an emergency dept. trolley throughout the day for a reason that was inexplicable to me.

I made sure to document the events very carefully (defensive medicine in action) and was sure to finish with ‘NO evidence of any physical injury’…

~ by Dr Ben on February 5, 2007.