Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Ethmoid Roof Penetrated During Sinus Surgery
The plaintiff, a 14-year-old boy, was evaluated by his pediatrician, then by a family physician, for pain in his left cheek and significant postnasal drip. He was given several courses of antibiotics, which did not relieve his symptoms. He was then referred to the defendant otolaryngologist, who recommended endoscopic sinus surgery.
The procedure, performed one month after the boy’s initial presentation, included four endoscopic bilateral procedures (total ethmoidectomy, maxillary sinus antrostomy, frontal sinusotomy, and reduction of inferior turbinates), in addition to partial resection of the left middle turbinate. The surgery left the patient with persistent bitemporal headaches, photophobia, and phonophobia.
The plaintiff claimed that during surgery, the right ethmoid roof was penetrated, causing a bone shard to become dislodged. A review of the materials sent to pathology after surgery, the plaintiff said, revealed the presence of brain matter. The plaintiff claimed negligence in the performance of the procedures and lack of informed consent.
According to a published report, a defense verdict was returned. Posttrial motions were pending.
”He Said, She Said” Over Obstetrics Patient
A 24-year-old woman expecting her second child went to the defendant hospital in labor. The defendant anesthesiologist, Dr. R., administered an epidural anesthetic block.
About 15 minutes later, the patient complained of difficulty breathing, and a nurse responded by raising the head of the bed, administering oxygen by mask, and calling Dr. R. to return to the room. The plaintiff soon complained of not being able to feel her legs and said she felt nauseous. She vomited and again complained of having trouble breathing.
The nurse made an emergency call for Dr. R. to return and began to administer oxygen using a manual ventilator. The anesthesiologist arrived, ordered the ventilation to be stopped, and pronounced the patient fine. The nurse, contesting this determination, placed a pulse oximetry clip on the patient; her oxygen saturation was measured at 62%.
The nurse urged intubation, but when Dr. R. attempted the intervention, he placed the tube into the esophagus rather than the trachea. The nurse then called a “code 99” emergency.
Responding members of the code team testified that Dr. R. had misplaced the intubation tube and that when the team leader attempted to reintubate the patient, Dr. R. shouted an expletive and shoved him away (which Dr. R. denied). Dr. R. then intubated the woman but did not secure the intubation tube. The code team leader also claimed that Dr. R. called for defibrillation, although the patient had a nonshockable rhythm.
An emergency cesarean delivery was performed, after which the code team defibrillated the patient. This maneuver apparently dislodged the intubation tube, necessitating a third intubation. The patient then began spontaneous respirations.
The plaintiff suffered anoxic brain injury. Despite three months of inpatient rehabilitation, she has the mental acuity of a five- to six-year-old and requires constant supervision.
Dr. R. denied that he was called the first time the nurse claimed to have called him. Dr. R. claimed that when he arrived, the plaintiff was turning blue; he argued that he, not the nurse, began to administer supplementary oxygen. He claimed that when he then attempted intubation, the plaintiff became agitated and broke the laryngoscope blade, necessitating reintubation. He also claimed that he, not the nurse, called the code.
The plaintiff claimed that the nurse had been negligent and that numerous late chart entries showed that she had ignored the plaintiff while she was decompensating. The hospital claimed that Dr. R. had placed a high epidural block, leading to the patient’s respiratory distress; this, along with Dr. R.’s failure to properly intubate the patient, resulted in her injuries.
According to a published report, a defense verdict was returned.
Anticoagulation Therapy Times Two
A 45-year-old woman who was taking warfarin underwent a cholecystectomy, with preoperative and postoperative medication adjustment based on her international normalized ratio (INR). IV heparin was administered after the surgery to raise her INR. At the time of the woman’s discharge, the primary surgeon prescribed her usual dose of warfarin. Unknown to the surgeon, a second-year resident also prescribed warfarin, as well as heparin injections.
The patient was instructed to follow up in the anticoagulation therapy clinic every three days. On the way home from her first visit there, she experienced a massive abdominal hemorrhage. Emergency laparotomy was required at a different hospital, where doctors were unable to identify the source of the bleeding.
Two weeks later, the patient was transferred to the original hospital. Shortly thereafter, she died of complications of a massive abdominal hemorrhage, including acute respiratory distress syndrome, sepsis, and multiorgan failure.
The plaintiffs claimed that the defendants were negligent in monitoring the decedent’s INR levels, which should have been done daily. The hemorrhage, the plaintiffs claimed, was caused by the heparin. The order was for heparin to be administered “per pharmacy protocol,” but the hospital pharmacy had no such protocol in place at the time. As a result, too much heparin was given.
The defendants contended that the decedent’s treatment was proper and that abdominal hemorrhaging is a known complication of anticoagulation therapy. Her hemorrhage, they claimed, was triggered by the restriction of her seatbelt when she drove over the railroad tracks on the way home from the anticoagulation therapy clinic. The defendants maintained that the decedent’s INR level was properly monitored and that the use of heparin was within the standard of care.
The matter was arbitrated, resulting in an award of $385,376.
Loss of Vision After Screening Colonoscopy
A 54-year-old man was referred to the defendant gastroenterologist for a screening colonoscopy. The patient had a family history of colon cancer and a long history of multiple medical problems, including four heart attacks, organic heart disease, diabetes, dyslipidemia, and hypertension.
The previous month, when testing revealed the presence of a kidney stone, the man’s blood pressure was 160/88 mm Hg. Before the colonoscopy, his blood pressure measured 93/50 mm Hg. He had no lightheadedness, dizziness, or chest pain.
An IV was started, and the patient was given meperidine and midazolam. After the scope was inserted, his blood pressure declined. The endoscopy nurse reported this to the gastroenterologist, who ordered an increase in IV fluids. The plaintiff’s blood pressure rose, and the procedure was completed.
In recovery, the patient was noted to be alert and oriented. He received a perfect score on discharge criteria and was released from the recovery area with a blood pressure reading of 90/60 mm Hg.
The man went straight to a donut shop, where he ate two donuts. He then experienced nausea that lasted throughout the afternoon, after attempts to eat and drink a number of items.
At about 4 PM, a call was made to the gastroenterologist’s office. The defendant returned the call, instructing the patient to report to the emergency department; the plaintiff later claimed that this was stated only as an option. Instead, the man elected to take an OTC antinausea medication and remain at home. The nausea subsided, and he went to bed and slept through the night.
When the man awoke at 5 AM, he was totally blind. He was taken to the hospital, where he was evaluated by a neuro-ophthalmologist and diagnosed with a posterior ischemic optic neuropathy.
The plaintiff charged that the rare form of blindness he experienced was the result of hypotension during the colonoscopy. He claimed that he was not given sufficient IV fluids to elevate his blood pressure and that he should not have been discharged home.
The defendant claimed that the plaintiff’s blindness was unrelated to the colonoscopy but resulted from hypotension that developed while he was sleeping.
An initial trial ended with a hung jury. At a second trial, a defense verdict was returned.