Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Were Neurologic Symptoms “Nonspecific”?
The plaintiff, age 41, had a medical history that included smoking, elevated blood pressure, cardiac catheterization, and left-eye blindness since childhood. One afternoon in January, he presented to the emergency department (ED) complaining of a sharp pain on the left side of his head since that morning.
The patient described blurry vision and “fluttering lights” in his right eye, although these had subsided somewhat. He also reported having a runny nose and a cough producing yellow sputum. His blood pressure was measured at 147/77 mm Hg. He was alert and oriented and had no motor or sensory deficits.
He had been seen initially in the hospital’s outpatient area by a physician assistant, who referred him to the ED. There, the patient was evaluated by the defendant ED physician, Dr. C.
The man’s right-eye visual acuity was 20/20, and the retina appeared normal on right-side funduscopy. Dr. C. ordered CT without contrast and a chest x-ray. CT showed no signs of acute intracranial hemorrhage, no signs of midline shift, and no acute infarct. The patient had mucosal thickening bilaterally in the ethmoid sinuses and in the right sphenoid sinus. Although no signs of pneumonia were found, he was given a respiratory treatment.
Dr. C. discussed the man’s care with another physician, but the records show no recommendations made by the other physician. The defendant made a diagnosis of “sinusitis and acute visual changes.” Antibiotics, ibuprofen, and cough medicine were prescribed. The patient was instructed to undergo an ophthalmology examination to rule out a detached retina.
The man went to the optometrist almost immediately. While in the examination chair, he became lethargic and developed right-side hemiparesis, aphasia, and diaphoresis. The patient was alert but not oriented, with right-side neurologic abnormalities. He was returned to the ED by ambulance less than two hours after his discharge.
When he was seen again by Dr. C., the man was aphasic and not moving his extremities. CT revealed an increased density in a branch of the left middle cerebral artery in the area of the sylvian fissure; this, in addition to slight hypodensity in a few left parietal gyri, was described as “new, compared with the earlier study.” No evidence of acute hemorrhaging was detected.
A diagnosis was made: an acute thrombus in a branch of the left middle cerebral artery, with evidence of acute infarct in the left parietal lobe. The patient was given a bolus of tissue plasminogen activator (t-PA) and a t-PA drip before being transferred to another hospital. At the receiving hospital, he was diagnosed with a dissected left carotid artery; this had caused the formation of a clot, which was released into the left middle cerebral artery.
The patient suffered significant permanent neurologic damage. He was transferred to a rehabilitation facility for therapy. He remains unable to walk without the use of a brace and a cane, and he is unable to speak more than a few words.
The defendants claimed that the plaintiff’s symptoms on initial presentation were nonspecific and consistent with the plaintiff’s prior episodes of headache and his history of eye problems. The defendants also argued that carotid artery dissection is a very rare condition.
A $400,000 settlement was reached during trial.
Career-Ending Fall From a Horse
After a record number of career victories, a 56-year-old jockey was thrown from his horse during a race and landed on his head. Two emergency medical technicians (EMTs) in a nearby ambulance rushed to the scene. At the jockey’s request, the EMTs helped him to stand up and walked him to the ambulance. The patient was transported a short distance to the track’s first aid station, where a PA examined him and released him with a diagnosis of cervical sprain.
Four days later, the jockey experienced severe neck pain, making it impossible for him to mount a horse. He went to the emergency department and was diagnosed with hangman’s fracture—a broken neck that includes fracture of an upper cervical vertebra. X-rays revealed a fracture at the C2 level, confirming the diagnosis. He was placed in a halo brace for two months.
The plaintiff was forced to retire from horse racing because of the risk of reinjury. He claimed that if he had received proper care on the day of the accident, he would have been able to return to riding. The plaintiff claimed that he should have been placed immediately in a neck brace and carried to the ambulance on a board, then taken to a hospital for care.
The defendant claimed that all the plaintiff’s injuries resulted from the accident and that even immediate diagnosis and treatment would not have changed the outcome. The defendant also argued that the plaintiff could not have been immobilized without his consent; the plaintiff asked for help to get up. He also made arrangements to return to riding during the four-day delay, during which he obtained a massage and underwent electric stimulus to the neck.
According to a published account, a $2.7 million verdict was returned.
Timeline Questioned for Oxycodone Overdose
A 23-month-old boy was believed to have taken several oxycodone tablets after his mother found her prescription bottle empty. The child was taken to the emergency department (ED) and seen by the defendant physician, who ordered administration of charcoal. This induced vomiting, but no evidence of the drug was found in the vomitus. A urine bag was ordered to obtain a sample to be checked for oxycodone, but the child never urinated while the bag was in place. He appeared normally playful and alert and was sent home four hours after his arrival at the ED.
Upon his return home, the child went to bed and slept through the night. He appeared normal the next morning. At about noon that day, however, he was found unresponsive, and his mother drove him to a hospital. The child was comatose and did not awaken. Life support was terminated the next day, and the boy died. His death was attributed to an oxycodone overdose.
The plaintiff claimed that the decedent should have been kept under observation longer, and that he should not have been released before producing a urine sample.
The defendant physician claimed that the child was properly treated and that if he had ingested oxycodone before his arrival at the ED, he would have been lethargic or showing other symptoms. The defendant also argued that the child would most likely have chewed the pills, which would have destroyed their time-release function. The defendant claimed that the child had consumed the fatal dose of oxycodone after he was seen in the ED.
According to a published report, a jury found the physician 20% at fault, the mother 50% at fault, and the child’s father 30% at fault, with damages assessed at $343,047. After apportionment of fault, the net award was to be $68,609.
Improper Labeling of Breast Tissue Specimen
At age 47, a woman underwent fine-needle aspiration at the defendant hospital, where she was employed as a nurse. Biopsy results were to be examined for possible breast cancer. The specimen was submitted to the cytopathology department, where a laboratory clerk received it for processing. The clerk placed the wrong identifying number on the plaintiff’s slides—that of a male patient who did have cancer. As a result, the woman received a misdiagnosis of breast cancer.
The patient underwent partial mastectomy and sentinel lymph node mapping, dissection, and removal. According to her claim, the surgeon had assured her that he would remove only one or two lymph nodes and that she should not expect any resulting functional problems (eg, lymphedema of the arm).
However, the surgeon actually removed seven lymph nodes and a significant amount of tissue from the breast and the area surrounding the lymph nodes. The surgeon’s explanation, the patient claimed, was that the cancer had spread to the lymph nodes. Her prognosis was deemed poor.
The patient’s excised breast tissue and lymph nodes were evaluated in the defendant cytopathology department, and the nodes were found negative for cancer. The surgeon was informed of these findings, but apparently he did not contact the patient; she logged onto the hospital’s electronic records herself and reviewed the report. The head of the cytopathology department informed the patient that her slides and another patient’s had been confused in the laboratory.
The plaintiff claimed to have undergone extensive surgery because of the laboratory’s failure to properly identify her test specimen, and she claimed to have developed lymphedema as a result of her unnecessary surgery. She also claimed that her position at the defendant hospital was terminated because she allegedly failed to provide a letter from her doctor allowing her to continue her medical leave. Finally, the plaintiff claimed that she had been traumatized by the erroneous diagnosis of cancer; as a result, she said, she now had posttraumatic stress disorder and was unable to work.
The defendants acknowledged that a clerical error had been made, but they claimed that at the time of her breast surgery, the plaintiff was already unable to work in the hospital because of hip and back problems. The defendants also argued that lymphedema in her arm alone would not have prevented her from working in nursing or in any occupation that did not require heavy or repetitive lifting.
According to a published report, a verdict of $3,042,456 was returned.