Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Brain Edema and Obliteration Result in Stroke
At age 42, a man went to a medical center emergency department (ED) complaining of severe headaches. CT revealed a midline shift in his brain, edema, and partial obliteration of the anterior horn of the right lateral ventricle. Eleven years earlier, he had had a sinus tumor removed.
The defendant radiologist made a diagnosis of encephalomalacia and gave the defendant ED physician a CT report, remarking that he wasn’t sure of its acuity. The plaintiff was then given narcotic pain medication and released.
Five days later, the plaintiff was found unresponsive. He was taken to a second hospital, where he was found to have experienced a stroke involving the middle cerebral artery and right posterior cerebral artery, near an undiagnosed brain swelling and infection. The plaintiff suffered left-side hemiparesis and spent 11 months in the hospital. He will require 24-hour care for life.
The plaintiff alleged negligence by the ED physician, his business partner, and the medical center’s ED group, as well as the medical center, the radiologist, and the radiologist’s group practice. The medical center settled for a confidential amount prior to trial.
The plaintiff claimed that when he first went to the ED, his CT scan was grossly abnormal and the treating physicians should have taken immediate action by referring him to a neurosurgeon; had this occurred, he would have undergone surgery within 24 hours and received antibiotics, which would have prevented the stroke.
The defendants claimed that the plaintiff had a Staphylococcus aureus brain infection that, even if treated with antibiotic therapy and possibly surgery, would have caused the stroke. The ED physician also specifically claimed that the radiologist did not give him sufficient facts about the plaintiff’s condition and that he (the ED physician) never saw the patient’s CT.
According to a published report, a verdict of $11,743,921 was returned against the ED physician alone. The matter had been bifurcated as to the responsibility of the defendants’ partnerships and the ED physician’s business partner, and that issue was still pending.
When Was Pulmonary Edema Evident?
In her 37th week of pregnancy with twins, a 28-year-old woman presented to the defendant hospital with nausea, vomiting, and diarrhea, as well as a two-week history of a cold with cough. Her blood pressure was initially elevated, and protein was found in her urine. Her oxygen saturation level on room air was 84% to 85%.
While in triage, where she was seen by Dr. R., the patient did not complain of shortness of breath or difficulty breathing. Orders were written for oxytocin to induce labor, cough medication, laboratory studies for pregnancy-induced hypertension, pulse oximetry monitoring, respiratory therapy, supplemental oxygen via nasal cannula at 2 L/min, and IV hydration. Fetal monitoring was also ordered.
The woman was transferred to labor and delivery about one hour after her arrival. During the following four hours, the fetal monitoring tracings remained normal. No indication of shortness of breath was noted in the mother, who received treatment from a respiratory therapist almost three hours after her arrival in labor and delivery. No evidence of fluid in her lungs was documented at this time, and her vital signs were unremarkable.
Shortly after the respiratory treatment, two readings of oxygen saturation on room air were recorded, both 98%. About one hour later, however, the patient’s respiration rate began to increase and her oxygen saturation declined. About two hours after the treatment, family members complained to the nursing staff that the woman was having difficulty breathing.
Dr. R. was called, and when she arrived shortly thereafter, clinical evidence of pulmonary edema was present. The patient was transferred to the ICU, where she soon experienced cardiopulmonary arrest. She was intubated and a pacemaker was placed in preparation for an emergency cesarean delivery. About 15 minutes after the birth of her twins, the woman was pronounced dead. One infant, a boy, was stillborn; the second, a girl, died several days later after life support was discontinued.
The family of the decedent alleged that Dr. R. failed to diagnose pulmonary edema when the patient first presented to the hospital and was negligent in ordering IV fluid, despite clinical evidence of fluid overload.
The defendant claimed that the treatment given was proper, that the decedent’s presentation was not typical, and that it was proper to administer IV fluid in anticipation of epidural or spinal anesthesia. The defendant maintained that pulmonary edema developed just before the woman’s death.
According to a published account, the hospital and the company employing some of the nurses involved settled before trial. A defense verdict was then returned.
Neurology Patient Agitated but Not Restrained
Shortly after finishing a long-distance bicycle ride, a 47-year-old woman complained of a headache. Early the next morning, her husband found her in bed, having a seizure. She was transported by ambulance to a hospital emergency department. Head CT revealed a blood clot. She was admitted to the ICU in the care of defendant Dr. K., who found a small hemorrhage in the patient’s brain associated with the clot. The woman was in an agitated state, and she was sedated, in addition to being given blood thinners.
The following evening, the patient was left alone temporarily. She was subsequently found on the floor with a head laceration. CT revealed a massive bleed in the brain. Emergency surgery was performed, but the woman was left permanently disabled.
The plaintiff claimed that restraints should have been used and that CT was delayed after her fall. The defendants contended that the hematoma was the result of the blood clot, not the fall.
The hospital settled with the plaintiff for an undisclosed amount before the case went to the jury. In the matter against Dr. K., a defense verdict was returned.
Dermatologist Forgoes Biopsy for Shoulder Cysts
In August, a 53-year-old man with a history of basal cell and squamous cell skin cancer and a family history of melanoma (his father) was referred by a primary care provider to the defendant dermatologist for possible excision of bumps on his right shoulder. The patient said the bumps had been present for quite some time and mentioned a history of epidermal inclusions. The dermatologist diagnosed the bumps as routine cysts, cut them open, and drained them. None of the tissue was sent for a biopsy.
During the succeeding three months, the man made seven visits to the dermatologist, who cut into the bumps and injected steroids to reduce redness and inflammation. None of the extracted material was sent for biopsy, and the bumps continued to recur.
In December, the man was referred to a surgeon, who assumed that the dermatologist had ordered tests and that the bumps were confirmed as cysts. The surgeon referred the patient to a plastic surgeon, who saw the patient in February. The plastic surgeon removed a section of skin from the shoulder and sent a tissue sample for biopsy. Results revealed squamous cell carcinoma.
An oncologist then made large cuts in the man’s shoulder to remove the cancer, but it had metastasized to the armpit, neck, and collarbone. The cancer was pronounced terminal. The entire trapezius muscle was excised, leaving a hole in the plaintiff’s right shoulder.
The plaintiff charged that the dermatologist should have ordered a biopsy during the first visit; this would have led to removal of the cancer, and metastasis would have been prevented.
The defendant argued the plaintiff had only a cyst when he treated him and that a biopsy was not necessary. According to the defendant, the plaintiff’s cancer was very aggressive; it originated farther down the plaintiff’s back than where the cysts were located, and nothing he could have done would have changed the outcome.
According to a published account, a $5,840,165 verdict was returned. The verdict was reduced to $1,690,165 under the state caps. An appeal was expected.