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Malpractice Chronicle


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

No Action Taken in Suspected Appendiceal Abscess
In 2002, a New Jersey man presented to the defendant family practitioner, Dr. W., with complaints of a cold, a sore throat, and abdominal discomfort. Dr. W. referred the patient to a county hospital for abdominal CT. A radiologist there found evidence of a prior appendiceal abscess but no evidence of inflammatory changes.

The radiologist recommended a clinical consultation to determine whether the CT results, when correlated with other clinical findings, indicated appendicitis or some other condition. On being questioned by Dr. W., the patient denied having any right lower quadrant pain.

The man continued to be seen by Dr. W. for longer than two years for various medical needs. One day at work in February 2005, the man began to experience severe abdominal pain in the right lower quadrant. He went to Dr. W.’s office and was sent to an emergency department (ED), where he was admitted to the hospital to undergo surgery to treat appendicitis, including removal of his appendix.

The postsurgical pathology report included a finding of appendiceal carcinoma, which had advanced to the point of perforating the wall of the appendix. In response to results from further testing, a right hemicolectomy was performed with removal of lymph nodes that were found negative for cancer.

The patient underwent chemotherapy and experienced no recurrence of the cancer. He did experience complications as a result of the hemicolectomy, however, which required lysis of adhesions in September 2005. In 2006, the man underwent surgeries for treatment of five hernias.

The plaintiff claimed that Dr. W. should have referred him to a surgeon in 2002 at the time of his initial visit. The plaintiff claimed that the CT findings made surgery necessary to confirm their cause and to prevent persistent appendicitis. The plaintiff claimed that surgery at that time would have led to a diagnosis of cancer prior to perforation of the appendix wall.

The defendant countered that in 2002, the plaintiff had no clinical complaints to warrant referral to a surgeon.

According to a published account, a defense verdict was returned.

Stroke and Intracerebral Hematoma After Anticoagulant Therapy
Several days after giving birth, a 33-year-old woman presented to the ED of a Michigan hospital with a recent history of dyspnea, chest pain, headaches, and abdominal pain. She was seen and treated by an emergency physician and an obstetrician/gynecologist. An order was issued for chest CT in accordance with a pulmonary embolism protocol, and heparin was administered. Following CT, the patient allegedly claimed that her chest pain had resolved. The attending radiologist’s report revealed no pulmonary embolism. The woman was discharged less than four hours later, without undergoing any further testing.

The next day, the patient went to the ED at a different hospital with complaints of headache and right-sided weakness. CT performed there revealed a large left parietal lobe intracerebral hematoma. Over the next two days, a ventricular catheter was placed and a stereotactic craniotomy was performed in order to evacuate the hematoma. The patient underwent two additional surgeries and was transferred to a rehabilitation facility about one month later. She was discharged home with permanent neurologic damage, including short-term memory loss and an inability to lift or walk for any great distance.

The plaintiff claimed that both physicians failed to diagnose and treat her acute neurologic event in a timely fashion and failed to obtain consults with appropriate specialists. The plaintiff claimed that the physicians were negligent in administering an anticoagulant and that protamine therapy should have been started to reverse the anticoagulant effects. The plaintiff claimed that laboratory testing of clotting times and a ventilation-perfusion lung scan should have been conducted to confirm or rule out the presence of a pulmonary embolism.

The defendants contended that the administration of anticoagulants was appropriate in the face of suspected pulmonary embolism. The defendants also denied any evidence that the heparin given to the patient the day before her stroke was a factor in the subsequent neurologic event. The obstetrician/gynecologist was dismissed from the case prior to trial.

According to a published account, a defense verdict was returned.

Severed Artery Missed After Stabbing
A Virginia man, age 29, was stabbed in a drunken brawl at the home of a friend. The weapon, an 18-inch “dragon dagger” (a curved blade with serration on one side), left a stab wound in the man’s left lateral thigh.

He was taken to a hospital ED within minutes, but on his arrival, he was hypotensive and barely conscious. The emergency physician began IV fluids, ordered a blood transfusion, and sutured the wound. He doubted that a major vessel injury was involved, considering the location of the wound.

About two hours after the patient’s arrival, the emergency physician called the defendant on-call surgeon to apprise him of the patient’s condition and to ask him to admit the patient to the ICU, which the defendant agreed to do. The defendant did not see the patient for three hours, by which time he was coding.

The patient was immediately taken to the operating room, where the defendant found and repaired a severed left internal iliac artery. The surgery took four hours, after which the patient developed disseminated intravascular coagulation and multiorgan failure. He died the next day.

The plaintiff alleged negligence in the defendant’s failure to respond immediately to the emergency physician’s call.

The defendant claimed he had not been told that the ­decedent was in extremis and hemorrhagic shock, or that the emergency department staff needed his help. The defendant also maintained that the emergency physician did not call him a second time. According to the defendant, he had been at the hospital for about 90 minutes after the call from the emergency physician but was not paged by the ICU staff about the decedent’s deterioriating condition for another 90 minutes.

According to a published account, a defense verdict was returned. A defense verdict had been returned earlier on claims against the emergency physician.

Unusually Severe Pain After Colonoscopy
A 49-year-old Michigan woman with persistent complaints of abdominal pain and diarrhea underwent a colonoscopy at a hospital outpatient surgery department in November 2003 to rule out colitis. After the procedure, which was performed by a gastroenterologist, Dr. T., the patient was given standard instructions for follow-up care, including contacting Dr. T. in the event of any unusual developments. She was also advised to follow up with Dr. T. in three to four weeks.

Later that afternoon, a call was made to Dr. T.’s receptionist to report that the patient was experiencing severe pain. On being informed of this, Dr. T. prescribed a 24-hour supply (five tablets) of hydrocodone/acetaminophen. The woman, who had a history of frequent pain medication use, was instructed to go to the hospital ED if the pain persisted.

The next day, the hospital’s anesthesia service made a routine postoperative phone call to the patient, whose husband reported that she had been experiencing severe left lower quadrant pain since the previous evening. He was told to contact the doctor the next day if her condition did not improve. No call was made.

Six days later, when the woman’s husband was helping her dress, he noticed a bruise on her stomach. She was taken to the hospital, where CT revealed a splenic hematoma. An exploratory laparotomy performed the next day revealed adhesions between the colon splenic flexure and the spleen. A splenectomy was performed. During a second exploratory laparotomy about two weeks later, a left subphrenic hematoma was found and drained. The patient was discharged in February 2004.

In addition to the splenic problem, the woman had an esophageal stricture, which left her unable to eat. She was given J-tube nutrition, which was not sufficient. She experienced several episodes of dehydration and was losing weight as a result of malnutrition.

Her case was transferred to another physician group. An operative surgical repair was considered but could not be performed unless the patient weighed at least 115 lb. She died in December 2004 weighing 70 lb.

The plaintiff claimed that the decedent suffered a large subcapsular splenic hematoma after the colonoscopy, necessitating the splenectomy. The plaintiff contended that the multiple surgeries and esophageal stenosis led to dehydration and malnutrition, preventing the possibility of treatment and resulting in the woman’s death.

Dr. T. claimed there was no negligence and that neither the decedent nor her husband followed up with him regarding her pain. Dr. T. argued that the decedent had reported what are known complications of a colonoscopy.

According to a published account, a defense verdict was re­turned. 

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