House M.D. Episode 2.08 The Mistake

Stacy informs House and Chase that their scheduled peer review disciplinary hearing has been moved up to the next day. Since this is Chase's first experience with the process, Stacy wants to walk him through it.

A mother named Kayla watches her daughters perform at an elementary school talent show when she feels a sharp pain. She doubles over and screams out in agony. Kayla is admitted with multiple joint and stomach pains. In a neurological exam, Foreman notices some inflammation of the iris. The team begins running through possibilities. Suspecting an STD, Chase gives her a pelvic exam. He finds some ulcerization and prescribes some meds.

The next day, Kayla returns to the hospital with pustules on her arm. This confirms Chase's feelings that it's Behcet's, and he sends her off to get an appointment with rheumatology. He also prescribes a stronger antacid after she mentions increased stomach pain. Chase later admits that not asking further about the stomach pain was a mistake -- a mistake that's at the heart of this matter.

An hour later, Chase has a nurse call Kayla back in, thinking she had something else important to say. Yet she is wheeled in by the EMTs after vomiting massive amounts of blood. This is a sure sign of a bleeding ulcer. Chase cauterizes the ulcer, but Kayla's blood pressure still drops. She also has a perforated ulcer, and Chase orders her into an OR.

The perforation caused sepsis, damaging Kayla's liver and kidneys. Despite making every effort to avoid doing so, Stacy is forced to talk to House about why Chase screwed up. House doesn't think he did, but House was actually highly critical of Chase at the moment. He yelled at him for not asking the patient simple questions.

Stacy asks Chase why he didn't ask those two simple questions. He's just as resistant and defensive as he was earlier. Stacy wants to know what happened after the surgery. Chase says that Kayla developed clots because the sepsis had lowered her blood pressure so much. Her liver was shot and she needed a transplant. Chase and House badger Cuddy into putting Kayla on the liver transplant list. House even admits that this all happened because of Chase's mistake.

Kayla's brother Sam doesn't want to wait for a donor and offers his own kidney. House somehow convinces the hospital's transplant surgeon to perform the live transplant, which is a risky maneuver. He had actually threatened to tell the surgeon's wife that the surgeon was sleeping with one of the nurses. Stacy advises House not to proffer this blackmail information to the committee.

Two months after the transplant, Kayla is back for a follow up exam with Chase. Noting a fever, Chase sends Kayla for cultures and a chest x-ray. Then the fever spikes. Foreman theorizes that Kayla is rejecting the new liver. Chase insists it is an infection. Sam comes into the office demanding more treatment for his sister. House notes his homemade tattoo, and Sam admits that he has hepatitis C. He had paid off a technician to say he was clean. What's worse, Sam's liver also had an undiagnosed hepatoma, which grew faster in Kayla. So Sam's liver gave Kayla both hep C and cancer.

The official malpractice lawsuit arrives and it seeks punitive damages of $10 million. What hasn't Chase told them? After Kayla's cancer blacklisted her from the transplant list, Sam finds a black market liver and had planned to take Kayla to Mexico City for a transplant. Before she could leave, Chase admits his mistake to Kayla. He said he had acted too hastily. He pleads with her to forgo the operation, which would certainly kill her.

Stacy points out that this admission wouldn't warrant the lawsuit. Sam later had returned to Chase for a follow-up. What happened in that meeting? Chase had confessed to Sam that he killed Kayla by not listening to her. He was hung over and just wanted to go home. Sam became enraged. House asks to see Chase outside. He knows that Chase lied to Sam because he wanted Sam to sue the hospital. The guilt he's feeling over Kayla forced him to.

What really happened is that Chase received a call from his stepmother with news that his father died right as Kayla came back into the clinic. House advises Chase to tell the truth so that the hospital can settle. He can continue to lie and lose his career.

After testimony from both House and Chase, the committee reaches a decision. Although Dr. Chase had lied, he will only be suspended for one week because he was reacting to his father's death. Although there is no evidence of a lack of supervision from House, there is a litany of troubling complaints and issues surrounding him. The committee recommends that House's practice be overseen for a period of one month by a doctor of Cuddy's choosing. Cuddy has chosen Dr. Foreman to oversee House.