STREPTOCOCCAL MENINGITIS AS A COMPLICATION OF DIAGNOSTIC MYELOGRAPHY - MEDICOLEGAL ASPECTS

Infections and their management are frequently the object of medicoleg al proceedings. During their professional lifetime, most doctors will seek legal advice because of patients' concerns that their treatment h as led to an undesired outcome (which is not, by any means, equivalent to negligence). In addition, doctors may appear as expert witnesses o n behalf of either the plaintiff or the defendant. Although over the y ears many doctors have altered their practice to meet criteria for ''d efensive medicine,'' this concept is often not well understood, and th e expectations of patients with regard to outcome of our intervention are uncertain. As well, our colleagues in both the health and legal pr ofessions often have varying expectations of our professional performa nce as providers of care. What are the legal responsibilities with reg ard to preventing infection and ensuring limits within which doctors p ractice ''usual care and diligence.?'' When does a doctor step outside these bounds and become culpable for injury to the patient? Gelfand a nd Cook begin the first of what we hope will be a series of case studi es that address some of these questions. In the two cases reported by Gelfand and Cook, it was determined that there was no medical negligen ce. Both of the individuals who had acquired streptococcal meningitis in association with a myelographic procedure recovered completely. How ever, Gelfand and Cook suggest that patients should be informed of thi s rare but serious complication of myelography before undergoing the p rocedure. Clinical Infectious Diseases would like readers to submit ma nuscripts that address medicolegal issues. Each submitted article will usually be reviewed by at least one lawyer and one physician with exp ertise in the area of infectious diseases. These articles will provide both interesting reviews of actual medicolegal procedure and ''case p recedents'' that will be useful for infectious disease specialists and attorneys. We invite your comments.