Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Melanoma Missed in Nail Bed Lesion
A man, age 51, visited his family practitioner with a raw spot in the nail bed of his right middle finger that would not heal. He was referred to a hand surgeon, who treated the lesion and sent a tissue sample to pathology in February 2004. The pathologist noted an abnormality, but testing for carcinoma was negative.
Over the succeeding eight months, the lesion did not heal, and antibiotics were prescribed. Swelling consistent with an infection developed in the patient’s elbow and armpit. When a second biopsy of the finger and elbow was performed in October, a diagnosis of melanoma was made. By that time, the cancer had metastasized to the man’s lungs, brain, and other organs. The original tissue samples taken in February were reexamined, and melanoma was found. The patient died in January 2005.
The defendants claimed that a reasonable work-up of the specimen had been done. They also argued that the cancer must have been so well developed in February that an earlier diagnosis made at that time would not have changed the outcome.
According to a published account, a $1.5 million verdict was returned.
Cephalohematoma and Seizures Blamed on Vacuum Extractor Delivery
The plaintiff infant’s mother, age 24, was admitted to the defendant hospital at 40 weeks, three days’ gestation for scheduled induction of labor. Labor progressed normally, with some nonreassuring fetal heart tones for part of the time. When the mother was completely dilated, she was told to start pushing.
Nonreassuring fetal heart tones occurred for a few minutes when the infant’s head was crowning. The defendant attending Ob-Gyn decided to use a vacuum extractor and allowed his first-year resident to perform the procedure while he supervised. The delivery notes indicated that only one pull was required for the baby to be delivered.
The newborn weighed 8 lb 15 oz. In the nursery records, no perinatal asphyxia was noted, but molding of the head was noted. The baby’s 25-hour hospital stay was uneventful, with no abnormalities seen.
Three days after the birth, a visiting nurse was sent by the hospital to check on the mother and the baby at home. She found that the baby was not feeding well and was jaundiced. The mother was advised to take the child to the hospital, where he was found to have a cephalohematoma.
The baby later suffered seizures and was taken to another hospital, where cephalohematoma and bleeding deep inside the brain were found. Vacuum delivery was a suspected cause, but abuse and/or neglect were also possible. X-rays were normal, and blood study results ruled out any bleeding disorder. The infant later developed mild cerebral palsy and continued to experience a seizure disorder. He also had mild behavioral problems and learning deficits.
The plaintiff claimed that a cesarean delivery should have been performed to avoid a traumatic delivery after nonreassuring fetal heart tones. The plaintiff claimed that the vacuum delivery was performed incorrectly and that the resident should not have been allowed to perform it. The plaintiff claimed that the vacuum was placed on the wrong part of the infant’s head, that excessive force was used, and that the head was pulled to one side, making delivery more difficult.
The defendants contended that a cesarean delivery was not necessary, based on reassuring fetal heart monitor strips and the infant’s normal neonatal course during his hospital stay. The defendants further argued against evidence of trauma, since the vacuum extractor succeeded with just one pull and was attached for only one to two minutes. The defendants suggested that the injury could have occurred after the child left the hospital. The defendants also maintained that the child was doing well and that his seizures could be corrected with surgery.
According to a published account, a settlement of $1,125,000 was reached. This included $200,000 from the Ob-Gyn’s insurer and the remainder from the hospital.
One of Two MRI Orders Never Processed
In early October 2005, a 52-year-old woman began to experience back pain and weakness in her legs. Two months earlier, she had had back pain that was attributed to an injury at the gym. Results on plain x-rays of the spine that were ordered by her family physician in October were negative.
Two days later, her symptoms became much worse. She experienced extreme weakness and numbness in one leg and began to have bowel and bladder difficulty. Her family physician admitted her to the hospital and ordered an MRI of the lumbar spine to rule out a tumor. He also requested a neurology consult. The neurologist examined the patient and formulated a differential diagnosis of either transverse myelitis or a tumor in the T10 area. The neurologist ordered a thoracolumbar MRI to rule out spinal cord compression.
Both MRIs were ordered through the hospital, but only the family physician’s lumbar MRI request was processed, and results were negative for tumor. According to a hospital chart note written by a nurse on the MRI report, the results were reported to the neurologist at 6:30 pm.
The neurologist denied ever receiving this call. He claimed that the next day, he spoke with a radiologist who informed him that the spine had been scanned up and down, and no tumor had been found. The neurologist did not chart this conversation, and he could not recall the name of the radiologist with whom he spoke. The neurologist did not chart that the MRI was negative, nor did he ever read the MRI report. The neurologist reached a diagnosis of transverse myelitis.
Within four days, the patient had lost the ability to bear weight on her legs and had lost all bowel and bladder function. The neurologist saw her every day and maintained the diagnosis of transverse myelitis.
In late November, the woman began to experience new symptoms in her hands. Another doctor ordered an MRI of the thoracic spine, which revealed a large tumor at T10. In spite of surgery, the woman remained completely paraplegic. She was given a diagnosis of stage 3 multiple myeloma.
The plaintiff charged the hospital with negligence for failing to perform the MRI ordered by the neurologist. She also charged the neurologist as negligent for failing to follow up on his order by reviewing the existing MRI report; doing so would have alerted him to the fact that the MRI he ordered was never performed.
The hospital conceded some fault but claimed that the neurologist was also negligent. The hospital also placed blame on the family physician for trying to read his own x-rays and claimed that a radiologist would have seen evidence of the tumor.
According to a published account, a $775,000 settlement was reached. This included $500,000 from the hospital and $275,000 from the neurologist.
Follow-Up Instructions Misunderstood—or Unheeded?
After a January 2000 motor vehicle accident, a 24-year-old man was transported to a hospital emergency department (ED). Among his lab test results was an elevated creatinine level of 2.6, and his blood pressure was slightly elevated. The defendant ED physician claimed that he told the patient he had had an abnormal kidney function test and believed it was understood that the patient would follow up with his family health care provider regarding this concern and his injuries from the accident. Since the patient felt fine despite his injuries, he did not follow up with his family clinician.
In August 2002, the patient experienced acute renal failure; it was discovered that he had only one kidney, and it had failed. He was placed on dialysis and at the time of trial was on a waiting list to undergo kidney transplantation.
The plaintiff claimed that the defendant had not made it clear to him that the follow-up visit was needed to investigate his creatinine level. The defendant contended that when he released the patient from the ED, the patient signed discharge instructions, including an agreement to seek follow-up treatment. The defendant claimed that the patient’s outcome was his own fault.
According to a published report, a verdict of $8.48 million was returned.