Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Slow to Diagnose, Slow to Treat for Respiratory Symptoms
During office visits to Dr. W. and Dr. F., a 29-year-old woman with impaired respiratory function was diagnosed with bronchitis. The physicians prescribed antibiotics and steroids, but Dr. W. ultimately determined that the patient required hospitalization.
The woman presented to a hospital emergency department (ED), where an ED physician opined that she might be experiencing a pulmonary embolism. Testing performed six hours later included a spiral CT scan and a ventilation/perfusion lung scan. An injection of enoxaparin sodium was ordered but not administered until 90 minutes later, during which the patient was examined by a pulmonologist. When she then became hypotensive, a cardiopulmonary emergency was declared, and the doctors confirmed a diagnosis of pulmonary embolism. The woman died nearly two hours later.
Plaintiffs charged that the defendants failed to make a timely diagnosis and administer appropriate treatment for pulmonary embolism. They claimed that Dr. W. and Dr. F. should have seen the decedent’s initial symptoms as indications of a possible pulmonary embolism. The plaintiffs also claimed that the hospital staff failed to respond promptly to the suspicion of a pulmonary embolism, taking six hours to begin testing and delaying administration of enoxaparin after it was ordered. The plaintiffs also claimed that a tissue plasminogen activator should have been administered.
The matter ultimately proceeded against Dr. W., Dr. F., and the hospital. The defendants denied any negligence in the matter.
According to a published account, a $5.9 million settlement was reached. This included $2.3 million from Dr. W.’s insurer, $1.0 million from the hospital’s insurer, and $300,000 from Dr. F.’s insurer.
Nonoperative Leg Neglected During Knee Surgery
A 43-year-old man underwent extensive knee surgery, which was performed by Dr. S. Anesthesiologists for the 10-hour procedure were Dr. T. and Dr. V.
During most of the surgery, the patient’s right leg was elevated in a padded leg holder and immobilized in the hemilithotomy position. Immediately after surgery, the man complained of pain stemming from his right calf muscle, which was also swollen.
The patient developed right-leg deep venous thrombosis (DVT). He also complained of injury to the tibial nerve and reflex sympathetic dystrophy, for which he required nerve-block injections.
The plaintiff claimed that the DVT resulted from excessive elevation of the right leg, charging that his leg was not properly positioned during the surgery. A $390,000 settlement was reached with Dr. S., and several other defendants were dismissed, leaving Dr. T. and Dr. V. as defendants at trial.
The plaintiff claimed that the anesthesiologists should have periodically asked Dr. S. to raise the leg off the holder for one minute and reposition it, ideally every one to two hours. Even with proper positioning and padding at the beginning of the surgery, he claimed, maintaining the hemilithotomy position throughout a surgery of that duration created a risk of blood clots, nerve compression, and tissue damage.
The defendants contended that there was no known maximum length of time for a nonoperative leg to safely remain in a leg holder in the hemilithotomy position. They contended that it was solely the surgeon’s responsibility to reposition the nonoperative leg during the surgery. The defendants also claimed that a properly padded, properly positioned nonoperative leg does not require repositioning. While acknowledging the plaintiff’s reflex sympathetic dystrophy, the defendants maintained that the plaintiff had not shown any objective signs of the condition since the year of the surgery.
According to a published account, a jury found Dr. T. 35% at fault, Dr. V. 35% at fault, and Dr. S. 30% at fault. The jury awarded $1.45 million. This sum was subject to an offset for Dr. S.’s percentage of liability, resulting in a net award of $1,015,000.
Diabetes and Depression a Bad Diagnostic Mix
A woman with a history of anorexia, depression, diabetes, and occasional hypoglycemia was seen by one of her treating endocrinologists, Dr. R., in May 2001. Previously, she had disclosed that her daily food intake generally consisted of a single meal. Although her diabetes had been controlled by twice-daily 30-mg doses of insulin, Dr. R. discontinued the insulin and prescribed oral glucose-controlling medications (ie, glimepiride, rosiglitazone, and metformin). The patient’s depression waned; she began to leave her home more frequently and started an exercise program. Her blood glucose levels fell to an acceptable level.
Shortly thereafter, the woman stopped seeing Dr. R. She also discontinued her exercise, and her depression recurred.
In June 2001, she went into a hypoglycemic coma and was transported by ambulance to a hospital emergency department (ED). Intravenous dextrose was administered. When the woman experienced a seizure, tests were performed that revealed she had consumed barbiturates and diazepam. Once she recovered, the woman admitted having experienced suicidal ideation. She was discharged with instructions to seek treatment from an endocrinologist and a psychologist.
A week later, the patient returned to Dr. R., who diagnosed catatonia. She was transported to a hospital, where clinicians ultimately diagnosed metabolic encephalopathy stemming from a diabetic coma. Insulin was prescribed after tests showed that the patient could not manufacture sufficient levels of insulin.
The plaintiff alleged negligence by Dr. R. in failing to properly diagnose and treat her condition; had Dr. R. ordered tests in May 2001, a correct diagnosis would have been made. She claimed that the encephalopathy impaired her cognitive functionality and contended that she would require counseling to redevelop her cognitive function. The plaintiff also claimed that she should have been referred to a nutritionist.
The defendant denied any negligence and maintained that the plaintiff’s coma was due to an attempted suicide. According to a published account, a defense verdict was returned.
Seven Years With Misdiagnosis of Panic Attacks
In 1994, a 61-year-old man was seen by a primary care physician for a complaint of mild seizures. He was given a diagnosis of panic attacks, treated with paroxetine, and given a recommendation for group therapy.
The patient’s symptoms persisted for seven and one-half years. Seizures were never considered in the differential diagnosis despite the patient’s atypical presentation for panic attacks. He was referred to a neurologist, but MRI was not performed for some time.
When it was, the man was diagnosed with an oligodendroglioma brain tumor, which by that time was the size of a racquetball. The tumor had begun to hemorrhage into itself and into the brain, causing intense intracranial pressure. The patient underwent partial resection of the tumor, but less than half of it could be removed, as it had grown into both hemispheres of the brain and across the corpus callosum.
Almost two years after the surgery, the man experienced a massive hemorrhagic stroke. He lived for another year but was severely disabled. He died in November 2004. The autopsy and death certificate both specified the tumor as the cause of death.
The plaintiff made a charge of negligence in the failure to diagnose the tumor in 1994, when a total resection surgery would have been possible. The plaintiff claimed that the decedent spent seven and one-half years believing that he had a mental problem while the tumor was growing. The decedent’s angry outbursts and other behavioral issues during that time, for which the family had sought explanations, were now attributed to the tumor.
The defendants argued that the decedent’s hemorrhagic stroke was unrelated to the tumor and that the tumor would have led to the man’s death in any event. The defendants also claimed that the delay in diagnosis allowed the decedent a better quality of life, as he would have had to undergo early invasive treatment that would have made no difference in the outcome.
According to a published report, a $4,511,000 verdict was returned.