Malpractice Chronicle, April 2008

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Oversedated, Unresponsive After Aneurysm Surgery
A 73-year-old man went to a hospital emergency department (ED) with complaints of chest pain, bloating, and blood in his stools. CT revealed an aortic aneurysm, and surgery was performed three days later. In the recovery room, the patient became confused and agitated. He managed to leave the building before several nurses were able to restrain him and return him to his room.

It was determined that the man was experiencing symptoms of alcohol withdrawal, making him uncooperative and potentially violent. He was started on a detoxification protocol, which included lorazepam and haloperidol.

Over the next several days, the patient appeared oversedated and unresponsive, and his lorazepam dosage was reduced. When he developed a rattle in his chest and began to have trouble breathing, no action was taken. He went into respiratory arrest and was intubated; during this procedure, he sustained a punctured lung. Although the man was resuscitated, he was left with anoxic brain injury. He remained in a deep coma until his ventilator was turned off.

Plaintiffs for the decedent claimed that he was oversedated. He developed a mucous plug that he was unable to clear because of physical restraints and a decreased level of consciousness.

According to a published account, a settlement of $107,500 was reached.

Discontinued Monitoring for Abdominal Cyst
The plaintiff child, an infant girl, was delivered in September by an Ob-Gyn from a women's health practice. Her mother had undergone serial fetal ultrasonography to monitor an abdominal cyst that was detected in the unborn child early in the woman's pregnancy.

During the eight weeks following hospital discharge, the child was seen numerous times by physicians at a pediatrics/adolescent medicine group for digestive issues, including nausea, vomiting, diarrhea, and pale-colored stools. In late October, the mother asked one of the pediatricians whether the infant's problems could be related to the cyst; she questioned whether the prenatal ultrasounds had been faxed to the pediatrician's office.

When no follow-up testing was ordered, the parents took the infant to another doctor, who had her admitted. She was diagnosed with a choledochal cyst (a congenital bile duct anomaly) and liver failure. During surgery, associated biliary atresia was also discovered.

In February, the infant underwent a liver transplant. She suffered one episode of liver rejection and will require a lifelong regimen of antirejection medications.

According to the plaintiff, an Ob-Gyn had assured the mother that an order for postpartum ultrasonography would be placed in the chart to ensure follow-up on the infant's cyst, but the test was never ordered. The plaintiffs also claimed that the Ob-Gyn never informed the pediatrics/adolescent medicine group about the cyst and that no information about the cyst was placed in the newborn's charts by hospital nurses. The plaintiff claimed that proper monitoring would have led to early intervention at a time when the infant's liver was salvageable.

The defendants contended that they had communicated properly and that the child would still have needed a liver transplant, even if testing had been conducted earlier.

During the trial, a confidential settlement was reached with the hospital and the pediatrics group. According to a published report, a $16.5 million verdict was returned against the women's health practice.

Abscess Develops Following a Fall
One day at work, a 54-year-old man fell off his chair and landed on his right hip. He did not seek immediate medical attention but was in considerable pain by the time he arrived home. During the night, his pain worsened, and his wife called an ambulance.

When the patient arrived at the ED, he was barely able to walk and reported a 9 on the 10-point pain scale. His skin moistness, color, and temperature were all normal. An IV was started, and the man was given morphine. When his pain persisted, he was given ketorolac tromethamine, meperidine, and hydroxyzine pamoate.

The ED physician made a diagnosis of acute lumbosacral strain and released the man with prescriptions and instructions for hydrocodone/acetaminophen and cyclobenzaprine. He was to be on bed rest for two days, remain home from work for two more days, and see his primary care provider in seven to 10 days if his condition had not resolved.

The man's pain became increasingly severe. He could not walk unaided, and after four days, he was pale or grayish in color, clammy, sweaty, and short of breath. On the fifth day, this US Army veteran kept an appointment at a US Air Force/university hospital–based clinic, where a second-year resident examined him, diagnosed muscle sprain, and prescribed a few more days of rest. The patient was not seen by the supervising physician.

The next day, the man was unable to urinate; the following day, he began to hallucinate. He was transported to an ED, where he was placed on life support. The day after his admission, CT confirmed the presence of a retroperitoneal (psoas) abscess and showed that the abscess was encroaching into the epidural space. By this time, his body had swelled to the point that his skin could no longer expand to accommodate it and had begun to crack.

A surgeon who was consulted diagnosed overwhelming sepsis, making the patient too unstable for surgery. By the time the decision was made to airlift him to the university hospital, the man was technically too heavy for the helicopter guidelines. He died one week later.

The case centered around a dispute regarding what the clinic's second-year resident had told the supervising physician regarding the decedent's symptoms. The court ultimately concluded that there was negligence on the part of both physicians, which led to the patient's death. According to a published report, a bench verdict of $8,265,009 was returned.

Infectious Mononucleosis Misdiagnosed as URI
A 19-year-old college student was treated by the defendant family practitioner, Dr. F., during repeated bouts of sinus infection and upper respiratory infection (URI). When the student's illness recurred in November while he was away at school, he was seen twice by an otolaryngologist. The student received a diagnosis of URI, for which he was given antibiotics and a steroid injection.

During the patient's winter break from school, he was still unwell. He called Dr. F.'s office for an appointment and was seen three days later. No lab work or tests were ordered, but Dr. F. made a diagnosis of strep throat and prescribed antibiotics. The student was also instructed that if his condition persisted or worsened, he should call Dr. F.

Two days later, the patient's mother phoned Dr. F.'s office to report that her son was experiencing severe abdominal pain. Because it was the weekend, the mother spoke with an on-call physician, who ordered a change in antibiotics. The patient's condition improved somewhat, but by the next afternoon, the pain had returned, and he was nauseated and vomiting.

He was taken to an ED, where a diagnosis of infectious mononucleosis was made. Less than an hour later, the patient went into cardiac arrest and died.

An autopsy revealed that the decedent's spleen had become enlarged to 10 times its normal size and ruptured, leading to massive internal bleeding and death.

The plaintiff alleged negligence in Dr. F.'s failure to diagnose infectious mononucleosis, claiming that the physician had not examined the decedent's abdomen during the office visit; had this examination been performed, the decedent's enlarged spleen would have been easily detected. The plaintiff further claimed that Dr. F.'s erroneous diagnosis had discouraged the decedent from seeking ED treatment when his condition first worsened.

The defendant denied any negligence, arguing that the decedent's death was an extremely rare complication of infectious mononucleosis and that the outcome would have been the same, even if the decedent had gone to the ED when his worsening symptoms began.

A defense verdict was returned.