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Malpractice Chronicle


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

Cesarean Delivery Too Late to Prevent Uterine Rupture
A pregnant woman with hypertension and associated medical concerns was admitted to the hospital for induction of labor. She had previously undergone a cesarean delivery.

Synthetic oxytocin was started. That evening, dinoprostone was administered, and synthetic oxytocin was substituted for it the following morning.

That afternoon, the patient complained of severe uterine pain. She was 3.0 cm dilated and 60% effaced; she was then given butorphanol tartrate.

Because labor was not progressing, the defendant obstetrician decided to perform a cesarean delivery, then left with the nurse to attend to another patient. When the nurse returned, she noted that the fetal heart rate tracing had become dangerously slow, and she paged the obstetrician.

By the time he arrived, the membranes had ruptured. A fetal scalp electrode was placed, revealing a fetal heart rate of 70 beats/min. A "stat" cesarean delivery was ordered.

Twenty-four minutes elapsed from the time the fetal heart rate anomaly was noted to the time the incision was made. The uterus was found to have ruptured; the infant, a boy, was floating in the woman's abdominal cavity under her diaphragm. He was resuscitated and transferred to a children's hospital, where he was diagnosed with hypoxic ischemic encephalopathy and choreoathetoid cerebral palsy.

The plaintiff charged the defendants with negligence in failing to perform the surgery earlier. The defendants denied any negligence and contended that the woman's complaints of pain were not extraordinary.

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

Conflicting Accounts About ED Referral for Man With Back Pain
After being given prescriptions for carisoprodol and hydrocodone with acetaminophen for back pain, a 26-year-old man returned to Dr. S., the defendant primary care physician, complaining of unremitting pain. Dr. S., who had been treating the plaintiff for staph infections, suspected a spinal epidural abscess. He prescribed naproxen, referred the patient to a laboratory for blood testing, and directed him to go to the emergency department (ED) if the pain worsened or if he developed neurologic symptoms.

That evening, the man's pain worsened, and he was taken to the ED. The ED physician considered a differential diagnosis that included epidural abscess. After consulting with the on-call primary care physician, the ED physician wrote holding orders for admission to the hospital. Very early the next morning, the patient complained to a nurse that he could not move his legs. Morphine was administered, and he slept for seven hours.

When he awoke, a nurse checked his status and reported that the patient was flaccid and paralyzed from the umbilicus down. Dr. S. came to see the plaintiff at about 11:00 am and discovered that he was paralyzed. Dr. S. ordered CT, then changed the order to one for MRI. In the hospital history, Dr. S. dictated that he had directed the patient to report to the ED the previous afternoon, but that he had refused.

The MRI revealed a large epidural abscess. Laminectomy was performed, and the abscess was removed.

The plaintiff never regained function in his legs, bowel, or bladder. He continued to experience spasms that were strong enough to eject him from his wheelchair.

The plaintiff alleged negligence by Dr. S., the hospital, and the ED physicians. The hospital and ED physicians settled for $1.25 million prior to trial.

At trial, the plaintiff claimed that Dr. S. had failed to properly refer him to the ED.

The defendant claimed that even if the plaintiff had been sent to the ED, he might not have undergone MRI and received treatment before paralysis developed. Dr. S. claimed that the hospital physicians and staff had delayed the diagnosis and treatment of the epidural abscess. He also claimed that he had instructed the plaintiff to go to the ED immediately because he might be at risk for paralysis, but the plaintiff had refused. Dr. S. argued that he ordered the blood work and prescribed naproxen only after the plaintiff refused to go to the ED. The plaintiff denied that Dr. S. had told him to go to the ED or risk paralysis.

According to a published account, a verdict of $9,420,840 was returned. Calculation of credit for the settlements and application of the 1975 Medical Injury Compensation Reform Act were pending.

Did Acne Medication Cause IBD?
For four months, a 14-year-old boy was treated with isotretinoin for acne. During this time, he noticed that he had chapped lips and achy knees.

Within the following year, the patient began to experience severe gastrointestinal pain, which was ultimately diagnosed as inflammatory bowel disease (IBD). Eventually, he underwent partial removal of his rectum and almost his entire colon.

After years of using a colostomy bag, the patient underwent surgery to connect the remains of his colon and anus, but there was not enough left of his colon to draw out excess water, and he now has permanent diarrhea.

The plaintiff claimed that the labeling for isotretinoin provided insufficient warning regarding the risk of bowel disease. The defendant manufacturer claimed that isotretinoin labeling had warned about IBD as a possible adverse effect for more than 20 years. The company also maintained that there is no significant scientific evidence to prove that the medication causes IBD.

According to a published report, a $2,619,000 verdict was returned.

Symptoms Should Have Prompted Repeat Urinalysis
In September 2002, a 62-year-old man with a 30-year history of smoking went to the defendant, his primary care physician, with a complaint of urinary symptoms. He had not undergone a general physical examination in three years.

Laboratory work was ordered. Red and white blood cells, protein, and bacteria were found in the urinalysis. The blood chemistry panel revealed elevated total cholesterol, slightly elevated glucose, and findings indicating a hereditary red blood cell abnormality.

During a subsequent phone call, the primary care physician made a diagnosis of urinary tract infection and prescribed antibiotics. The patient told the physician that he was experiencing discomfort and pain during urination. Whether the patient was advised to return for repeat laboratory studies once he had completed the prescribed antibiotics was later disputed.

In March 2003, the man presented to a gastroenterologist for a screening colonoscopy, as recommended by the defendant in September 2002. The man mentioned to the gastroenterologist that he was experiencing urinary discomfort and frequency. The gastroenterologist ordered urinalysis, and red and white blood cells, bacteria, and protein were found once again. Ten days later, the patient visited a urologist, who performed a cystoscopy and made a diagnosis of bladder cancer. Surgery revealed that the cancer had metastasized into a lymph node.

The patient underwent chemotherapy, but in early 2006 the cancer recurred in his liver and hip joint. He died in March 2006.

The plaintiff, the decedent's widow, alleged negligence by the defendant primary care physician in failing to repeat the urinalysis (she claimed to have overheard the phone conversation in question and denied hearing any such instruction) and in failing to stress the importance of returning for repeat urinalysis. The plaintiff claimed that if the cancer had been diagnosed earlier, her husband would have had a high probability of survival.

The defendant maintained that the decedent had been treated properly and that the defendant's advice to repeat the urinalysis had been ignored. The defendant also claimed that he was not required to inform the decedent of any risk for bladder cancer. Additionally, the defendant claimed that the decedent had an extremely aggressive, high-grade bladder cancer that had most likely metastasized before September 2002.

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

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