Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
ICU Nurses Fail to Report Loss of Pulses
At age 71, a woman underwent elective surgical repair of an abdominal aortic aneurysm. After the surgery, pulses were documented in both feet and the patient was able to move all her extremities. When she was transferred to the ICU, however, she was reported as having loss of sensation and movement in both legs. She later lost pulses in both feet, and the loss of pulses was documented throughout the overnight shift of one of the ICU nurses.
When the surgeon returned to the hospital the next morning, he determined that the aortic graft repair had occluded, requiring a second surgery to reestablish blood flow. The woman was left with partial paralysis of her legs and was eventually required to undergo below-knee amputation of both legs.
The plaintiff claimed that the hospital was liable for its nurses’ failure to recognize the signs and symptoms of graft occlusion, failure to contact a physician about the changes in the patient’s condition, and failure to obtain intervention.
The defense argued that the nurses acted reasonably and appropriately, including keeping the surgeon fully updated on the patient’s condition throughout the night.
According to a published report, a $4,741,000 verdict was returned.
Second Neurosurgery Makes Matters Worse
By age 45, the patient had a long history of back problems, beginning with a traumatic injury and Pott’s disease during childhood. In her early years, she also developed a kyphotic deformity, for which she underwent a surgical correction. Yet as she matured, she experienced little pain and few restrictions.
After the birth of her fourth child in 1999, the patient began to experience severe back pain stemming from her kyphotic deformity. In 2000, she underwent corrective surgery, performed by the defendant neurosurgeon at a US Army medical center. He performed a three-level vertebrectomy at T12, L1, and L2. A titanium mesh cage was inserted anteriorly, with screws placed above and below the cage.
The surgery was unsuccessful. When the plaintiff sought a second opinion in April 2002, she was diagnosed with a nonunion of the fusion site and pseudoarthrosis. Surgical exploration of the fusion was recommended, along with removal of the hardware and a re-fusing of the spine.
Because of insurance requirements, the patient had to return to the defendant neurosurgeon. He determined that there was no nonunion and extended the hardware several levels on both ends to reduce the kyphosis. This surgery, too, was unsuccessful, resulting in flat back syndrome, a substantial loss of lumbar lordosis, and excruciating pain. Two more surgeries were performed a year later at another facility, where it was found that the nonunion and pseudoarthrosis had not been repaired during the second surgery. The most recent surgeries largely corrected the kyphosis and somewhat reduced the woman’s pain.
The plaintiff claimed that the defendant neurosurgeon failed to make a correct diagnosis of a nonunion and pseudoarthrosis. She contended that she would not have suffered two years’ severe back pain or required multiple surgeries if a proper diagnosis had been made initially. The defendant claimed that the treatment provided was appropriate.
According to a published report, a bench trial ended with a $1,771,430 verdict, including $200,000 for loss of consortium.
Was Hematology Consult Timely, as Claimed?
The plaintiff, age 37, presented to the defendant primary care physician complaining of fever, chills, night sweats, weakness, and achy muscles. The defendant ordered stool cultures, a chest x-ray, urinalysis, urine culture, and a complete blood count (CBC) with differential and erythrocyte sedimentation rate (ESR). Results from the stool cultures and chest x-ray were negative. Urinalysis and urine culture showed 3+ protein, 3+ blood, and 1+ bacteria, as well as elevations in red and white blood cells. CBC results included a hematocrit of 24.1%, hemoglobin of 8.0 g/dL, and an ESR of 132 mm/h.
The man returned to the defendant a few days later and was informed of the abnormal findings. A double-contrast barium enema was performed two days later with unremarkable results. The defendant then ordered renal ultrasonography, which revealed an enlarged spleen and echogenic kidneys consistent with renal disease. The patient also underwent an upper gastrointestinal study with abdominal x-ray, both of which yielded negative results.
The defendant then referred the patient to a hematologist for evaluation of his anemia. The hematologist noted a grade 2 systolic murmur over the aorta and a grade 2 systolic murmur over the apex. Testing revealed a decreased albumin level and increased levels of alpha 1 globulin, alpha 2 globulin, and gamma globulin; blood cultures were positive for Streptococcus constellatus.
The patient then underwent echocardiography, which showed mitral valve vegetations and severe mitral regurgitation. The patient was given a diagnosis of endocarditis. He underwent surgery for mitral valve replacement and has been taking warfarin since the surgery.
The plaintiff claimed that the defendant should have ordered a blood culture sooner. The defendant argued that he had ordered more than the required testing in order to reach a diagnosis and that the plaintiff had been referred to the specialist in a timely fashion.
A $500,000 settlement was reached.
Should Emboli, Thromboses Have Been Suspected?
At age 51, a man with a history of type 2 diabetes mellitus and hypertension underwent fusion of a portion of the spinal lumbar region. After a procedure that lasted 10 hours, the patient was kept overnight for observation. During that time he was intubated, sedated, and kept in a paralyzed state. Unstable vital signs, agitation, listlessness, and jerking movements of the body were noted. The patient also attempted to expel the intubation, making optimal ventilation impossible. He was extubated the next morning.
The patient soon developed significant metabolic acidosis and also became hypotensive and asystolic. He was then reintubated and a prophylactic dose of low-molecular-weight heparin was administered. He remained intubated, sedated, and chemically paralyzed.
Later that day the defendant neurosurgeon consulted the defendant pulmonologist regarding management of the patient’s intubation. Four days later, intubation, sedation, and paralysis were discontinued. During the ensuing 11 days, the patient intermittently exhibited symptoms that included persistent shortness of breath, pain from the chest and groin, and tachycardia.
Sixteen days postsurgery, the patient suffered a massive, fatal pulmonary embolism. Autopsy revealed that the main pulmonary arteries were completely occluded by massive organizing thrombi, that the small pulmonary arteries were occluded by several infarcts in the lower lobes, and that an elongated embolus occupied the right ventricle of the heart.
The plaintiff alleged negligence in the failure to diagnose the emboli and thrombi. The plaintiff claimed that the decedent’s postoperative symptoms were indicative of emboli and deep venous thromboses, and that diagnostic testing should have been performed to rule these out.
The defendants claimed that the symptoms were caused by asthma and pneumonia and that the emboli and thromboses developed suddenly, just prior to the patient’s death.
According to a published account, a jury found the two physicians equally responsible for the patient’s death and awarded $1 million in damages. Posttrial motions were pending.