Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Recommendation Unheeded for Endocrinology Referral
A middle-aged man was referred by his primary care physician to the defendant pulmonologist in October 2002 for a sleep apnea consult. The patient complained of snoring, gasping for air at night, and daytime drowsiness. The pulmonologist, noticing that the man had coarse facial features, asked him whether anyone had ever mentioned facial changes to him; the man replied, “No.” The pulmonologist ordered blood work, including a random growth hormone sampling to test for excessive growth hormone.
The pulmonologist advised the patient to see his primary care physician for a possible referral to an endocrinologist. The man was also sent for an overnight sleep study to be tested for sleep apnea. The pulmonologist communicated with the patient’s primary care physician, mentioning the possibility of acromegaly and recommending an endocrinology consult. The primary care physician did not provide the referral to an endocrinologist, however.
The plaintiff returned to the defendant two months later for results of his sleep study. During that visit, the defendant informed him that findings from the growth hormone test were inconclusive. He advised the patient to return to his primary care physician for an endocrinology referral. The plaintiff was also instructed to return to the defendant pulmonologist in one month. The plaintiff never returned to the defendant and did not return to his primary care physician for 17 months.
The man was ultimately diagnosed with acromegaly, the production of excess growth hormone by the pituitary gland. He lost 90% of his pituitary gland and complains of double vision, cranial nerve injuries, hypopituitarism, diabetes insipidus, and sexual dysfunction.
The plaintiff claimed that the defendant pulmonologist wrote an “ambiguous” letter to the primary care physician (also a defendant in the case) that failed to specifically direct that physician to order an endocrinology consult. The plaintiff also claimed that results of the growth hormone test should have been forwarded to the primary care physician. The plaintiff claimed that diagnosis of acromegaly and appropriate treatment in 2002 or 2003 would have led to a cure for the pituitary tumor.
The defendant argued that his correspondence was clear regarding the need for an endocrinology consult and that forwarding the laboratory report was not required because results were inconclusive. The defendant also claimed that even with earlier treatment, the plaintiff’s condition would have been unchanged.
According to a published account, a defense verdict was returned. The primary care physician settled for an undisclosed amount prior to trial.
Post–Cesarean Surgery Complaints Overlooked
A woman underwent a cesarean delivery, performed by the defendant obstetrician with the assistance of two surgical nurses. At the conclusion of the procedure, the nurses informed the obstetrician that the sponge count was correct, and the surgical wound was closed.
About five months later, the patient complained of pain and tenderness in her abdomen; two months later, she went to the emergency department (ED) and was instructed to consult with her primary care physician. At that time, the patient did not have any pain but said her abdomen was “hard.”
One week later, the patient was seen by a different obstetrician/gynecologist, who ordered an abdominal CT. The test revealed that a surgical sponge had been retained during the cesarean delivery. The woman underwent surgery at the original hospital for removal of the sponge. The hospital eventually wrote off the charges for this surgery.
The plaintiff charged the nurses with negligence in miscounting the sponges and the defendant obstetrician for failing to refer her to another provider to determine the cause of her pain. A $159,000 settlement was reached with the hospital and the nurses.
The matter proceeded against the obstetrician, with the plaintiff claiming that the obstetrician should not have relied solely on the nurses’ sponge count and that she should have been more diligent about responding to the plaintiff’s complaints after the surgery.
The defendant claimed that she had acted appropriately in relying on the nurses’ sponge count and maintained that the plaintiff had no signs of fever or infection when she saw her two months after the surgery. The defendant also claimed that she repeatedly referred the plaintiff to other health care providers, including a neurologist and her primary care physician. She argued that the plaintiff had gone to the ED at least twice and had undergone ultrasonographic tests that did not detect the presence of the sponge. Finally, the defendant maintained that the plaintiff had no residual complications following the removal of the sponge.
According to a published report, a $375,000 verdict was returned. The court then ruled that the defendant obstetrician was entitled to a set-off against the verdict for the earlier $159,000 settlement. This reduced the plaintiff’s verdict to $216,000.
Failure to Diagnose Colon Cancer in Clinical Trial Subject
In August 2000, a 56-year-old man with a five-year history of Crohn’s disease was referred to Dr. B. for enrollment in a clinical trial of recombinant human interleukin 11 for treatment of Crohn’s disease.
Before seeing Dr. B., the patient had undergone abdominal CT. This revealed a 1.0-cm lesion on the liver that a radiologist had pronounced benign. The CT report was given to Dr. B., who recommended a laparotomy as the best strategy for the patient’s condition. However, the patient chose not to have the surgery and instead opted to participate in the clinical study.
Several times during his treatment with Dr. B., the man complained of abdominal pain, diarrhea, and constipation. He continued to participate in the study until March 2001, when he went to a hospital with abdominal pain. At that time, Dr. B. withdrew the patient from the drug trial.
One month later, the man returned to Dr. B., who recommended surgery once again. In August, the patient went to a second hospital with worsening abdominal symptoms. He received a diagnosis of colon cancer with metastasis to the liver. He died one week later.
The plaintiff alleged negligence in the failure to diagnose and treat the decedent’s colon cancer. The matter was ultimately tried against Dr. B. alone. The plaintiff claimed that Dr. B. should have followed up on the decedent’s abdominal CT, including investigation and treatment of the liver lesion. The plaintiff also claimed that the decedent’s reported abdominal pain, diarrhea, and constipation were not properly treated; earlier diagnosis of the decedent’s colon cancer would have increased his chance of survival, it was argued.
Dr. B. denied any negligence, main-taining that the decedent had not followed his recommendation for a laparotomy at the first visit and had ignored subsequent recommendations for surgery. He also defended his reliance on the radiologist’s opinion that the liver lesion was benign. If the cancer had already metastasized by the time he first saw the decedent, then there was nothing he could have done to change the outcome, he argued.
According to a published account, a defense verdict was returned.
Vascular Compromise After Surgery for Complex Tibia Fracture
After a serious motorcycle crash, a 39-year-old man was taken to a hospital emergency department, where he was treated by the defendant orthopedist for a complex tibia fracture and dislocation. Because vascular compromise in the leg was a concern, regular circulatory checks were ordered. Surgery was performed two days later, and the plaintiff began rehabilitation on day 4 of his hospitalization.
Two days later, nurses identified vascular compromise in the man’s foot, which was attributed to a popliteal artery injury. Surgery was performed, but the patient’s condition necessitated an above-the-knee amputation.
The plaintiff claimed that the amputation was required because of failure to provide proper monitoring or to identify the arterial injury. The defendants argued that the man’s care and monitoring were proper and that the need for amputation resulted from the serious injury he sustained in the motorcycle crash.
According to a published report, the jury awarded $604,000 in damages, with 70% negligence assessed to the orthopedist and 30% to the hospital.