Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Failure to Note Worsening Thoracic Aneurysm
A 47-year-old man with a history of a thoracic aneurysm went to a hospital emergency department (ED) with complaints of back pain and nausea. The ED physician, aware of the presence of the aneurysm, ordered chest CT to rule out any changes in the man’s condition. The films were taken to the radiology department and sent via teleradiology to a radiologist in another state for interpretation; the patient’s previous radiographs, which had been used to diagnose the thoracic aneurysm, were also sent to the remote radiologist. The ED physician requested that the old and current CT studies be compared and any changes noted.
According to the remote radiologist’s report, no change had occurred in the appearance of the thoracic aneurysm. The patient was then discharged from the ED with instructions to see his family clinician if symptoms persisted.
The man continued to experience pain and discomfort for the next several days and died five days later as a result of a ruptured thoracic aneurysm. In the days succeeding the patient’s death, other hospital radiologists reviewed the CT studies taken the day of the decedent’s ED visit and determined that they showed an enlarged thoracic aneurysm that had already begun to leak.
The plaintiff claimed that surgical repair of the aneurysm should have been performed.
A $500,000 settlement was reached.
Refusal to Admit Homicidal/Suicidal Patient
A 71-year-old man was referred to the defendant hospital ED after expressing suicidal thoughts. He had experienced recent-onset depression following the death of his wife of 38 years and his recent retirement. The man was referred to the hospital’s psychiatric unit for evaluation, but the hospital psychiatrist did not admit him. The psychiatrist did not examine the patient or speak with him before deciding not to admit him.
Over the next week, the man visited two other medical facilities before returning to the defendant hospital ED. The triage nurse made a note that the patient wanted help because he said he was afraid he might hurt his family or himself. The ED physician determined that the man was homicidal and suicidal and ordered an evaluation by the psychiatric unit.
The defendant psychiatric nurse performed the evaluation in the ED, which was not a secure area of the hospital. She noted that the patient had been suicidal at the earlier visit and was now homicidal. She relayed her findings to the hospital psychiatrist in a telephone conversation. The psychiatrist did not admit the patient, but the ED physician would not discharge him and asked the psychiatrist to reconsider her decision. The psychiatrist continued to refuse the patient admission.
Meanwhile, the man was left unattended in an unlocked, unsupervised room. He walked out of the hospital and drove home. When this was discovered, the ED physician executed an order for involuntary emergency hospitalization.
Police were contacted by the hospital but were not informed that the involuntary hospitalization order had been executed. There was also some confusion regarding the patient’s correct name. A sheriff’s deputy went to the man’s home and spoke with him but left without taking him into custody. The deputy was subsequently directed to return to the man’s home, where he found him hanging in the back yard.
The plaintiff alleged negligence in not admitting the decedent to the hospital and in failing to place the decedent in a secured area while he was being evaluated. The defendants claimed that the ED physician and nurses made every attempt to hospitalize the patient and that their actions had not contributed to his death.
According to a published report, a $1 million settlement was reached with the hospital.
Physical Illness Mistaken for Psych Disorder
In October 1993, a 24-year-old woman presented to a hospital ED with a two-week history of headaches and frequent vomiting. After four days of evaluation and treatment, the patient (an Army dependent) was referred to a military-operated facility where she was examined by Dr. G. Determining that the woman’s symptoms were not attributable to any medical disorder, Dr. G. issued medical clearance and referred her to a mental health unit in another hospital. She underwent involuntary admission there and was assigned to a psychiatrist, Dr. M.
Dr. M. made a diagnosis of organic dementia or psychotic depression but acknowledged that the patient’s condition might have a physical cause. Her vomiting continued with greater frequency. In response to this development, Dr. M. consulted the woman’s family practitioner, who recommended gastrointestinal testing.
The patient’s condition deteriorated, and she became immobile and mute. She was then transferred to the psychiatric unit of a large Army hospital. In late December 1993, clinicians there determined that her symptoms were the result of acute disseminated encephalomyelitis, which had caused widespread diffuse damage to the woman’s brain. She underwent 10 weeks of inpatient occupational and physical therapy at the Army facility before being transferred to a rehabilitation hospital. There, she underwent two months of additional inpatient treatment, followed by several weeks of outpatient treatment.
The plaintiff claimed residual impairment of her auditory ability, cognitive functionality, gait, and vision. The plaintiff alleged negligence in the clinicians’ failure to properly diagnose her condition. The matter was tried to a defense verdict in December 2005, then remanded for a new trial on appeal. The plaintiff reached a settlement with the original hospital before the second trial, at which Dr. M. was the only defendant.
The plaintiff charged Dr. M. with failure to recognize a neurologic disorder and contended that she should have been referred to a neurologist. The plaintiff claimed that timely administration of corticosteroids would have prevented much of the brain damage she sustained.
Dr. M. claimed that the plaintiff’s prior treating doctors had determined that she was not experiencing any medical abnormalities and that her family practitioner was immediately consulted when an organic problem was suspected. Furthermore, according to the defendant, there is no proof that corticosteroids effectively treat acute disseminated encephalomyelitis.
A defense verdict was returned, with posttrial motions pending.