Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Insufficient Monitoring for Cancer Patient With Pneumonia
A 53-year-old woman who was undergoing chemotherapy for breast cancer received a diagnosis of pneumonia from her oncologist, who prescribed antibiotics for her to take at home. When the patient had no response to the antibiotics, her oncologist admitted her to the hospital under the care of the defendant internist. The oncologist and the internist agreed to call in a pulmonologist to provide assistance in treating the woman’s pneumonia.
She did not respond well to the antibiotics administered in the hospital and experienced respiratory distress. The defendant internist called in and ordered a nonrebreather oxygen mask. The nurses contacted the pulmonologist, who stated that since the patient was at 100% oxygenation, there was no need for him to come in to see her.
The internist called in again and was told by staff that the patient’s condition was stable. Her spouse visited with her until 10 pm. Staff nurses checked on her at 2 am.
At 4 am, the decedent was found dead on the bathroom floor. An autopsy confirmed that she had died of bronchopneumonia.
The plaintiff claimed that the defendant violated the standard of care by not seeing the decedent after her respiratory crisis and by not transferring her to the ICU for oxygen monitoring. The defendant argued that he had ordered oxygen monitoring but claimed that the nursing staff failed to follow his order. The defendant further contended that he had requested the pulmonologist to examine the decedent after her respiratory crisis.
The plaintiff settled with the hospital for an undisclosed amount prior to trial. According to published reports, a defense verdict was entered.
Complications From Laparoscopy—or Preexisting Condition?
A woman in her 30s had a long history of abdominal surgeries, beginning with a ruptured appendix and serious infection at age 8. She complained of abdominal pain throughout her teens and underwent additional surgeries in 1991 and 2002.
The plaintiff was seen by the defendant surgeon in March 2003 regarding her abdominal complaints. A decision was made to perform a laparoscopic cholecystectomy in April. Shortly after the surgery, the defendant left town.
The next morning, the plaintiff experienced “bileish” discharge. The defendant returned that evening and advised her that a second surgery would be needed to repair a suspected bowel perforation. The surgery was performed that night.
The plaintiff was discharged a week after the initial surgery but continued to have problems. She was hospitalized a few days later, then transferred to another hospital under the care of other physicians, at her husband’s request. She was left with a nonhealing abdominal wound and lesion.
The plaintiff claimed that she was not an appropriate candidate for surgery and that the procedure should not have been performed laparoscopically. Further, the defendant’s medical license had been placed under a mandatory restriction, and she charged that this fact should have been disclosed to her.
The defendant claimed that the plaintiff had insisted on a laparoscopic procedure and argued that bowel perforations and other complications are known risks of such an operation. The defendant claimed that the plaintiff’s current problems were related to her preexisting history of abdominal problems.
According to a published report, a defense verdict was returned.
Impaired Blood Flow to Injured Leg Goes Untreated
A few days after being struck by an automobile in a parking lot, a Massachusetts woman presented to her primary care physician’s office, where she was seen by the defendant nurse practitioner. The NP noted a large abrasion on the patient’s left leg with some purulent drainage, as well as a large bruise on her back. The woman reported that her left leg felt cooler to the touch than her right leg.
She was instructed to go to the emergency department (ED) if she experienced any worsening pain, numbness, or tingling. Two days later, the patient was seen again by the defendant NP, during which visit she repeated her complaint of coolness in her left leg. She also told the NP that her leg was becoming progressively colder toward her foot and toes and that her toes were slightly discolored.
The woman was given an appointment to see the primary care physician the following week. When he examined her, the physician noted some swelling in the plaintiff’s left lower leg and found that her left great toe and second toe were dusky in color. She had palpable but diminished pulses in the left leg, compared with the right. The patient was given an appointment to see a surgeon.
The next day, the defendant surgeon examined the woman and noted that the toes on her left foot were bluish and felt cold, and that the plaintiff had faintly palpable bilateral femoral pulses but no palpable pulses in the popliteal or posterior tibial or dorsalis pedal area. Doppler ultrasonography showed intact posterior tibial pulses bilaterally but no dorsalis pedal pulse on the left.
The surgeon developed a plan that included repeat ultrasonography of the woman’s left leg in two weeks. He also told her that it would be fine for her to leave the next day for a vacation in Maine.
The following day, because her condition was worsening, the patient went to another surgeon with severe left foot pain and discoloration. She was hospitalized immediately and underwent an angiogram. The imaging revealed a thrombus in the proximal superficial femoral artery with a complete occlusion of the popliteal artery above the knee.
She was operated on twice during the next two days in an attempt to restore meaningful blood flow to her leg. The surgeries were unsuccessful, and she was transferred to another hospital for possible leg salvage. Attempts were unsuccessful, and the woman underwent amputation of her left leg above the knee.
The plaintiff alleged negligence by the NP in failing to admit her to the hospital when she reported the cool leg and foot, and by the first surgeon in failing to hospitalize her when she had an obvious lack of blood flow to the leg and foot. The plaintiff claimed that her foot and lower leg could have been saved if she had undergone surgery at any time before the day she was hospitalized.
The defendants denied any negligence and claimed that clots forming in the small vessels of the leg made saving the leg impossible.
A $2 million settlement was reached.
No Investigation of Elevated Hemoglobin and Hematocrit
Over the course of several years’ treatment of an elderly man with a medical history that included colon cancer, hypertension, type 2 diabetes mellitus, and Parkinson’s disease, the defendant primary care physician had ordered various tests. On several occasions, the patient’s hemoglobin and hematocrit values were elevated. The defendant physician ordered no further testing to investigate these findings.
When the man presented to the defendant with cyanosis in one of his fingers, he was referred to a vascular surgeon to be assessed for possible peripheral vascular disease. The surgeon ordered a number of tests, including a transesophageal echocardiogram, and started the patient on warfarin. During the procedure, his blood pressure became extremely elevated. He was admitted to the ICU, where he was noted to have difficulty speaking and swallowing. CT showed that he had experienced a cerebral infarct.
It was determined during the man’s hospitalization that he had polycythemia vera, which causes the blood to be abnormally thick and poses an increased risk of stroke. CT performed the day after this discovery revealed a hemorrhage in the brain stem. The patient’s condition deteriorated, and he died a few weeks later.
The plaintiff claimed that the decedent’s elevated hemoglobin and hematocrit should have been investigated earlier. The defendant claimed that the decedent’s stroke was unrelated to the elevated hematocrit or to polycythemia vera and that earlier treatment of the blood disorder would not have prevented the vascular injury that occurred.
According to a published account, a $250,000 settlement was reached.