Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Was Follow-Up Adequate After Neurosurgery in Cancún?
Shortly after arriving in Mexico for a brief stay, a 44-year-old woman collapsed in the customs area. She was taken to a hospital in Cancún, where she underwent emergency neurosurgery for a brain bleed. After several days of hospitalization, she was stabilized and returned to Michigan with instructions to see her family clinician.
Her appointment was delayed by an ice storm, which interrupted power to the office of the defendant internist, Dr. M. That Saturday, the woman visited the office’s clinic and was examined by the defendant family practitioner, Dr. P. She presented with a shaved head and a neurosurgical scar on the left side of her head; she complained of headache and some blurred or double vision. She gave Dr. P. a list of medications and medical records (in Spanish) from the Mexican hospital.
Findings on her physical examination were normal. She was instructed to return to see Dr. M., and she did so at the clinic on the following Monday. She repeated her complaints of double vision, headache, and fatigue. Dr. M. charged his office staff with attempting to have the Mexican records translated and to arrange for a neurosurgery appointment.
The patient was ultimately scheduled for head CT and an office visit with a neurosurgeon six days later. The day after those arrangements were made, however, she experienced a massive brain bleed and died.
According to the plaintiff, the surgeons in Mexico drained the blood from the initial bleed but did not detect its source—an aneurysm in the subarachnoid space. The plaintiff alleged that the defendants should have hospitalized the decedent immediately upon her return from Mexico or sent her for an immediate neurosurgical consult. Had the decedent undergone CT immediately, it was argued, the aneurysm would have been detected, surgery would have been performed, and she would have survived.
The defendants argued that the neurosurgical follow-up was out of their area of expertise and that they made appropriate arrangements for the decedent to be seen by a neurosurgeon. They maintained that the decedent appeared stable and seemed to be improving and that it was possible that the fatal bleed was not related to the first bleed. The defendants also claimed that definitive treatment should have been given in Mexico.
According to a published report, a defense verdict was returned.
Ultrasound Misplaced, Diagnosis Delayed for a Year
In March 2003 at age 2, the minor plaintiff was admitted to the defendant hospital under the care of the defendant pediatric urologist, who was treating her for bilateral vesicoureteral urinary reflux and frequent urinary tract infections (UTIs). The defendant surgically reimplanted both ureters to stop urinary reflux. The toddler was discharged to home in her parents’ care two days after the procedure.
The child continued to experience UTIs. Renal ultrasonography revealed a blockage in the left ureter, but the ultrasound was lost by the defendant hospital. Results were never conveyed to the ordering physicians, who failed to follow up to obtain them.
In April 2004, the defendant urologist diagnosed the condition and determined that it had gone untreated for a year. Repeat renal ultrasonography demonstrated the blockage, and a nuclear renal scan confirmed that the child’s left kidney was no longer functioning at all as a result of urinary backup. In addition to losing all function of the left kidney, the child has compromised function in the right kidney. She is expected to require dialysis in the future and eventually kidney transplantation.
A $9.75 million settlement was reached.
Complications of Undiagnosed Diverticulitis
A 62-year-old woman visited the defendant internist with complaints of abdominal pressure, poor appetite, weakness, and dizziness. Her medical history included hypertension, diverticulitis, hysterectomy, and tonsillectomy.
The defendant ordered a chest x-ray, complete blood count, and urinalysis. After reviewing test results, the defendant made a diagnosis of urinary tract infection and prescribed ceftriaxone by intramuscular injection and oral ciprofloxacin.
After receiving the first injection of ceftriaxone, the patient called the defendant’s office, complaining of increased discomfort. She requested admission to the hospital, which was allegedly refused by a member of the office staff. The following day, the plaintiff was transported to the hospital by ambulance with complaints of left lower quadrant pain, intermittent for one week and worsening that evening. The plaintiff reported no nausea or diarrhea but was belching.
The emergency department physician identified tender palpation in the abdomen with no rebounding and decreased bowel sounds. The defendant internist’s answering service was contacted, and the covering physician ordered admission with a diagnosis of diverticulitis. CT of the abdomen and pelvis revealed evidence of free air under the hemidiaphragm, ascites, and phlegmonous reaction; the results also suggested diverticulitis with perforation in the rectosigmoid region and inflammatory changes.
Five hours later, the patient was taken to surgery for an exploratory laparotomy and colostomy to address the apparent perforated diverticulum. Her immediate postoperative course included profound hypotension with narrow-complex tachycardia. These developments, allegedly resulting from abdominal sepsis due to the delay in diagnosing the perforated diverticulum, necessitated pressors and dopamine.
Soon thereafter, the patient developed right-leg ischemia. She underwent embolectomy and thrombectomy to the right common femoral artery and the superficial femoral artery, with repair to the right profunda by use of a saphenous vein patch angioplasty. Two days later, the patient was taken to surgery for an above-knee amputation.
The plaintiff claimed that the defendant was negligent in failing to recognize early manifestations of diverticulitis and to order CT or MRl. The plaintiff also claimed that she should have been hospitalized when she requested admission.
The defendant maintained that the patient’s history and the laboratory study results suggested that she had the flu or a urinary tract infection and that hospitalization was not needed. The defendant also maintained that when he called for a surgical consultation, the surgeon did not arrive for four and one-half hours.
According to a published report, a defense verdict was returned. A motion for a new trial was pending.
Surgery Continued Despite Patient’s Deteriorating Condition
In 1986, the patient, then age 8, was found to be mildly mentally retarded (IQ, 59 to 70). He also had paranoid schizophrenia, causing him to hear voices in his head. The patient lived with his sister, who served as his guardian.
At age 19, the patient was scheduled to undergo surgery to correct curvature of the spine. The operation was to be performed by Dr. R., assisted by Dr. M. and by an anesthesiologist, Dr. L.
About one hour into the surgery, the patient began to manifest decreased urinary output with no known cause, but the procedure continued. About 90 minutes later, an equipment malfunction made it impossible for the medical team to monitor the patient’s nerve responses and oxygen levels, but the surgery still continued.
At some point during the surgery, the patient had an unexplained blood loss and his serum calcium level dropped below normal. He also experienced a loss of oxygen to the brain, then went into cardiac arrest. At that point, the surgery was discontinued, uncompleted.
The patient was comatose for several days, during which he displayed prolonged seizure activity. After regaining consciousness, he remained in the hospital for nearly four weeks before being transferred to another facility for rehabilitation.
The patient continues to have symptoms of various neurologic problems, including athetoid-choreiform movement, which causes a general loss of balance and muscular control and cognitive deficits, which make him unable to communicate.
The plaintiff claimed that the surgery should have been stopped when the problems arose. The plaintiff also claimed that Dr. R. should have ordered intraoperative lab work when the plaintiff’s condition deteriorated.
The matter was ultimately tried against Drs. R. and L. only. They denied any negligence.
According to a published report, a $3 million verdict was returned.