Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Sedation Masks Neurologic Damage
While making pizza deliveries, an 18-year-old man was involved in a motor vehicle collision. The delivery vehicle was T-boned by two cars whose drivers were racing with their headlights off. The patient was taken to a hospital, where he was diagnosed with a fractured femur, facial fractures, cuts, and abrasions. He was given a Glasgow Coma Scale score of 15 out of 15. CT was read with normal results.
The man began to develop respiratory problems, and other patients were arriving, so the decision was made to transfer him to another facility. The plaintiff was intubated for flight, which required sedation and pharmacologic paralysis.
At the receiving hospital, the patient was assessed by an emergency department (ED) physician and a trauma surgeon. Both doctors suspected an acute closed head injury. Sedation and pharmacologic paralysis were continued in the ED and after the man’s transfer to the ICU; this made it impossible to conduct an accurate neurologic assessment. The patient’s health care providers relied on the fact that he had previously been pronounced neurologically stable and had had normal CT results.
After transfer to the lCU, the man’s facial injuries were repaired. In the early morning hours he was transferred to the operating room for repair of the femur. During this surgery, the patient sustained a 20- to 30-minute period of hypotension, which persisted after his return to the ICU. Medications were administered for the hypotension, and sedation was continued for several more hours. When the patient did not wake up, sedation was discontinued.
CT was ordered, and it revealed mild to moderate brain swelling. Mannitol and other agents were administered. A neurology consult was obtained, and an intracranial pressure monitor was placed.
Eventually, the plaintiff was diagnosed with a severe brain injury. He has undergone considerable rehabilitation and treatment, but his prospects for further recovery are not promising.
The plaintiff claimed that the receiving physicians should have been on the alert for deterioration of the plaintiff’s neurologic status and that the sedation should have been discontinued so that an accurate neurologic assessment could be performed. The plaintiff also claimed that surgery to repair the femur was not appropriate without a current accurate assessment of his neurologic status.
The defendant claimed that the plaintiff’s brain injury was caused by the collision and was not related to his subsequent medical care. According to the defendant, the plaintiff’s brain scans revealed diffuse axial injury, which is not amenable to treatment. The defendant also claimed that it was reasonable to have relied on the negative CT results and the normal neurologic examination from the transferring hospital.
After the underlying motor vehicle accident claim was resolved, the malpractice action and the plaintiff’s workers compensation claim proceeded. The medical malpractice claims were resolved with a $2,375,000 mediated settlement.
Bedsore Requires Debridement, Leads to Sepsis
At age 58, a man underwent coronary artery bypass surgery in July 1999. Shortly after the procedure, the patient experienced a stroke. He remained hospitalized in the defendant facility under the care of Dr. W., the defendant physician.
Several weeks later, the patient developed a sacral bedsore. He underwent three surgical debridements but developed sepsis. The bedsore allegedly worsened until the man’s death in January 2000.
The plaintiff claimed that the defendants failed to properly reposition the decedent and failed to treat the bedsore appropriately as soon as it developed. The plaintiff reached a confidential settlement with the nurses involved, and the matter proceeded against Dr. W. He claimed that the decedent’s diabetes made it impossible for the wound to heal and that nothing would have changed the outcome.
According to a published account, a $300,000 verdict was returned. A posttrial motion was pending.
Hernia Repaired, Recurrence Overlooked
A woman with a diagnosis of paraesophageal hernia was referred to the defendant surgeon, who recommended and performed laparoscopic surgery. The procedure involved reduction and repair of the patient’s large paraesophageal hernia, followed by Nissen fundoplication. A chest x-ray performed two days later revealed a large hiatal hernia, small to moderate-sized bilateral pleural effusions, and atelectasis in the left lung base. The woman was discharged from the hospital the next day.
Three days later, she presented to the emergency department, complaining of abdominal pain and shortness of breath. Chest x-rays again revealed the hiatal hernia, and no improvement was seen on repeat chest x-rays the next day. An upper gastrointestinal (GI) study was ordered. During the test, the patient’s condition declined, and she was transferred to the ICU.
After exploratory surgery revealed a constriction of the stomach and tissue necroses, the patient underwent cholecystectomy, resection of the proximal two-thirds of the stomach, and esophagogastrostomy with insertion of a feeding jejunostomy tube. Despite additional surgery, the woman died a few days later as a result of acute respiratory distress syndrome.
The plaintiff claimed that the defendant surgeon should have followed up on the chest x-ray following the initial surgery. On the patient’s return to the hospital, it was additionally charged, he should have inserted a nasogastric tube and ordered CT or an upper GI series immediately.
The defendant claimed that paraesophageal hernia repairs tend to fail and that it was not alarming that the hernia had recurred. The defendant maintained that the decedent’s symptoms were consistent with gas bloat syndrome, a common side effect of Nissen fundoplication. The defendant also claimed that even if the recommended diagnostic workup had been initiated earlier, she would have died in any event.
A defense verdict was returned.
House MD Forgoes Cardiology Consult
A 60-year-old woman was brought to the defendant hospital’s emergency department (ED) complaining of chest pain, nausea, and diaphoresis. She reported a family history of heart disease and a personal history of hypertension and high cholesterol.
In the ED, the patient was treated with aspirin and nitroglycerin. ECG revealed an old inferior infarct and was consistent with acute anterior ischemia. A diagnosis of unstable angina was made. The patient was admitted to a cardiac telemetry unit, and the on-call cardiologist was asked to consult. The plan for care included serial ECG and enzyme studies.
Shortly after midnight, the house officer was contacted by a unit nurse and informed about a report of an elevated troponin level. The house officer saw the patient, but his examination failed to elicit complaints of chest pain or shortness of breath and he pronounced it unremarkable.
Six hours later, the woman was found in cardiac arrest. Her heartbeat was restored, but she had experienced brain damage. She was transferred to another hospital for cardiac catheterization and stenting. Cardiac catheterization revealed single-vessel disease, with 99% to 100% occlusion of the left anterior descending artery. The decedent did not regain consciousness and was placed on a ventilator. A week later, she was removed from the ventilator and died.
The plaintiff claimed that the house officer should have ordered a stat cardiology consultation, which would have led to appropriate treatment and prevented the decedent’s massive myocardial infarction and death.
According to a published account, a $600,000 settlement was reached.