This case involves a male patient who presented to an urgent care facility complaining of abdominal pain that had been persistent for several days. The patient was seen by a nurse in the walk-in clinic, who consulted with a physician who was not located on-site but was available for consultation via telephone. At the clinic, the patient was assessed by the nurse and physician over the phone, who diagnosed him with a likely ureteral stone. At the time that this diagnosis was made, the nurse voiced concerns that the patient may be septic and conveyed this to the remote physician, but her concerns were dismissed and never investigated. The following day the patient’s condition continued to grow worse, at which point he presented to the emergency room. After being admitted to the hospital, the patient waited for more than a day before he was seen by a urologist, after which he was taken to the operating room to have a stent placed to relieve his urinary blockage. The stent was placed without incident. Shortly after the stent was placed, the patient developed disseminated intravascular coagulation, at which point he coded and was successfully revived. After this incident, the patient was noted to have vastly decreased urine output, as well as a continuation of his disseminated intravascular coagulation with a substantially lowered platelet count. Doctors noted that the patient had no detectable pulse in his extremities, and that there was evidence of early stage tissue necrosis on his hands and feet. Over the next several hours he was found to have tissue necrosis in all four limbs, which required amputations of both feet and hands. Subsequent testing revealed no signs of urinary stones, and indicated that the patient’s original symptoms were likely the result of sepsis.
