Malpractice Chronicle

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

Signs and Symptoms of Preeclampsia Repeatedly Overlooked
During her second pregnancy, a 23-year-old Michigan woman received prenatal care from Dr. L., beginning in April 2004. Her due date was December 2004.

In late November, the woman presented to a hospital emergency department (ED) with chest pain, cough, and shortness of breath. She was admitted with noted high blood pressure and tachycardia. During her hospitalization, the patient was examined by an emergency physician, who discharged her with a diagnosis of bronchitis and dyspnea.

Two days later, the patient returned to Dr. L. for a scheduled prenatal visit, at which time she still had high blood pressure. She was instructed to go to a second hospital; there, she was seen by a PA, who noted edema in her extremities. Attempts to draw blood for arterial blood gas analysis were unsuccessful, and crackles were noted throughout the woman’s lungs. An obstetrician/gynecologist, Dr. D., was contacted regarding worsening preeclampsia with pulmonary edema. It was decided to perform a cesarean delivery.

The woman became unresponsive on the way to surgery. After delivery, she experienced cardiopulmonary arrest and sustained an anoxic brain injury. She was declared brain dead and died after life support was withdrawn.

Upon autopsy, the cause of death was determined to be anoxic encephalopathy due to respiratory arrest caused by preeclampsia. The plaintiff claimed that Dr. L. failed to provide proper prenatal care and failed to recognize the signs and symptoms of preeclampsia, which the plaintiff alleged were evident in October. The plaintiff also claimed that the emergency physician at the first hospital failed to recognize the signs and symptoms of preeclampsia and failed to contact a specialist and to hospitalize the decedent immediately for monitoring and treatment.

As for the PA and Dr. D., the plaintiff claimed that they negligently administered a bolus of IV fluids when the decedent showed signs of preeclampsia, failed to administer proper dosages of furosemide, and failed to admit the decedent in a timely fashion.

The defendants all denied any negligence.

According to a published report, a $1.5 million settlement was reached.

No Action Taken on Abnormal Blood Cultures
Headache, fever, chills, vomiting, and wide-ranging muscle pain prompted an Indiana woman, age 44, to present to a hospital ED. She was examined by the defendant emergency physician, Dr. M., who ordered tests and made a diagnosis of influenza.

He ordered acetaminophen and prescription-strength ibuprofen and discharged the woman to home with instructions to consume copious amounts of fluid. Two days later, the laboratory staff contacted the ED by phone to report that the patient’s blood culture results were abnormal, indicating a possible bacterial infection. No one on the ED staff acted on this information.

Shortly before midnight the following evening, the patient returned to the ED complaining of similar symptoms. Based on the results of additional testing, acute renal failure and shock secondary to necrotizing soft tissue were diagnosed. The patient was transferred to another hospital, where she underwent extensive treatment, including several surgeries to remove infected tissue. The woman died, however, as a result of multiple organ failure and septic shock secondary to group A streptococcal infection.

The plaintiff alleged negligence by Dr. M. for his failure to investigate the possibility that the patient had a bacterial infection. The plaintiff also alleged negligence on the part of the ED personnel for their failure to act on the notification from the lab. The defendants denied any negligence.

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

Claim Heart Spasm, Not MI, After Treadmill Stress Test
A California man, age 51, saw his primary care physician and internist, Dr. C., and reported a 20-minute-long episode of chest pain in bed that morning. He also said he had had chest pain two mornings earlier, also in bed, that lasted longer than an hour. The patient had cardiac risk factors of obesity, hypertension, a history of smoking, and a strong family history of dyslipidemia and heart disease.

Dr. C. performed an ECG, with results interpreted as normal. He then prescribed a treadmill stress test, which was administered four days later by a cardiologist, Dr. W. The patient was able to complete the test, with his heart rate measured as high as 160 beats/min. Dr. W. interpreted the stress test as normal. The man did not complain of chest pain during the test. His blood pressure, which was expected to rise during the test, remained flat.

About 30 minutes after leaving the treadmill lab, the patient was found in full cardiac arrest at his desk at work. Paramedics were called, but he could not be resuscitated.

An autopsy revealed evidence of MI on the posterior portion of the heart, which corresponded with the complaints of chest pain about a week earlier. The decedent had 75% narrowing of the left anterior descending coronary artery, 75% narrowing of the right circumflex artery, and 30% narrowing of the right coronary artery. No thrombus or plaque rupture was identified. The cause of death was determined to be MI secondary to fatal arrhythmia, associated with coronary artery disease.

The plaintiffs claimed that Dr. C. should have included unstable angina in the differential diagnosis and should have assumed that the decedent had had a heart attack until proven otherwise. The plaintiffs claimed that the ECG taken in Dr. C.’s office was subtly abnormal and that the decedent should have been sent to a hospital immediately; there, they argued, blood would have been drawn and abnormal troponin levels detected. The plaintiffs claimed that the decedent would have then been sent to the catheterization lab for treatment—most likely, stenting.

The plaintiffs further claimed that Dr. W. took an inadequate history and that a treadmill test should not have been performed. The plaintiffs claimed that a myocardial perfusion test or nuclear imaging should have been performed. Further, the plaintiffs maintained that the ECG portion of the treadmill test had subtle abnormalities that Dr. W. overlooked, and that Dr. W. failed to appreciate the abnormality in the decedent’s blood pressure remaining flat during the test.

Dr. C. claimed that the decedent’s claims of chest pain at night suggested that the pain was not cardiac in origin. Dr. C. also claimed that he had acted reasonably in performing and interpreting the ECG. Dr. W. claimed that a treadmill stress test was appropriate for the decedent and that test results were normal.

The defendants both argued that the cause of death was not coronary artery disease, but coronary spasm. They maintained that there was only 50% narrowing in the coronary arteries and that the absence of thrombus or plaque rupture was inconsistent with a classic cardiac death resulting from coronary artery occlusion.

According to a published account, a defense verdict was returned for Dr. W. The jury was undecided in the case against Dr. C.

Obstetrician “Forgets” to Perform Tubal Ligation
A young woman in California became pregnant with her fourth child, although she was using birth control. During her prenatal care, she and her husband told the defendant obstetrician that they did not want, nor could they afford, any more children. They requested a bilateral tubal ligation at the time of a cesarean delivery, which was scheduled for a week before the projected due date.

The woman went into labor two days before the scheduled surgery. The prenatal records could not be found and the obstetrician’s office was closed. He delivered the baby by cesarean section but did not perform the tubal ligation. The mother was in the hospital for three days and was seen by the defendant for a six-week postpartum visit, but she claimed he never told her that he had not performed the tubal ligation. The mother did not take precautions to prevent pregnancy and subsequently conceived her fifth child. The plaintiffs did not opt to abort.

The plaintiffs alleged negligence and wrongful birth, contending that they were never told the tubal ligation had not been performed until after the fifth child was conceived.

The defendant claimed he told the mother at her six-week visit that the tubal ligation had not been performed and advised her to use birth control until she recovered from the cesarean delivery, when she could then undergo a tubal ligation. The obstetrician acknowledged that he had forgotten to perform the tubal ligation but insisted that there was no negligence involved.

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

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

Signs and Symptoms of Preeclampsia Repeatedly Overlooked
During her second pregnancy, a 23-year-old Michigan woman received prenatal care from Dr. L., beginning in April 2004. Her due date was December 2004.

In late November, the woman presented to a hospital emergency department (ED) with chest pain, cough, and shortness of breath. She was admitted with noted high blood pressure and tachycardia. During her hospitalization, the patient was examined by an emergency physician, who discharged her with a diagnosis of bronchitis and dyspnea.

Two days later, the patient returned to Dr. L. for a scheduled prenatal visit, at which time she still had high blood pressure. She was instructed to go to a second hospital; there, she was seen by a PA, who noted edema in her extremities. Attempts to draw blood for arterial blood gas analysis were unsuccessful, and crackles were noted throughout the woman’s lungs. An obstetrician/gynecologist, Dr. D., was contacted regarding worsening preeclampsia with pulmonary edema. It was decided to perform a cesarean delivery.

The woman became unresponsive on the way to surgery. After delivery, she experienced cardiopulmonary arrest and sustained an anoxic brain injury. She was declared brain dead and died after life support was withdrawn.

Upon autopsy, the cause of death was determined to be anoxic encephalopathy due to respiratory arrest caused by preeclampsia. The plaintiff claimed that Dr. L. failed to provide proper prenatal care and failed to recognize the signs and symptoms of preeclampsia, which the plaintiff alleged were evident in October. The plaintiff also claimed that the emergency physician at the first hospital failed to recognize the signs and symptoms of preeclampsia and failed to contact a specialist and to hospitalize the decedent immediately for monitoring and treatment.

As for the PA and Dr. D., the plaintiff claimed that they negligently administered a bolus of IV fluids when the decedent showed signs of preeclampsia, failed to administer proper dosages of furosemide, and failed to admit the decedent in a timely fashion.

The defendants all denied any negligence.

According to a published report, a $1.5 million settlement was reached.

No Action Taken on Abnormal Blood Cultures
Headache, fever, chills, vomiting, and wide-ranging muscle pain prompted an Indiana woman, age 44, to present to a hospital ED. She was examined by the defendant emergency physician, Dr. M., who ordered tests and made a diagnosis of influenza.

He ordered acetaminophen and prescription-strength ibuprofen and discharged the woman to home with instructions to consume copious amounts of fluid. Two days later, the laboratory staff contacted the ED by phone to report that the patient’s blood culture results were abnormal, indicating a possible bacterial infection. No one on the ED staff acted on this information.

Shortly before midnight the following evening, the patient returned to the ED complaining of similar symptoms. Based on the results of additional testing, acute renal failure and shock secondary to necrotizing soft tissue were diagnosed. The patient was transferred to another hospital, where she underwent extensive treatment, including several surgeries to remove infected tissue. The woman died, however, as a result of multiple organ failure and septic shock secondary to group A streptococcal infection.

The plaintiff alleged negligence by Dr. M. for his failure to investigate the possibility that the patient had a bacterial infection. The plaintiff also alleged negligence on the part of the ED personnel for their failure to act on the notification from the lab. The defendants denied any negligence.

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

Claim Heart Spasm, Not MI, After Treadmill Stress Test
A California man, age 51, saw his primary care physician and internist, Dr. C., and reported a 20-minute-long episode of chest pain in bed that morning. He also said he had had chest pain two mornings earlier, also in bed, that lasted longer than an hour. The patient had cardiac risk factors of obesity, hypertension, a history of smoking, and a strong family history of dyslipidemia and heart disease.

Dr. C. performed an ECG, with results interpreted as normal. He then prescribed a treadmill stress test, which was administered four days later by a cardiologist, Dr. W. The patient was able to complete the test, with his heart rate measured as high as 160 beats/min. Dr. W. interpreted the stress test as normal. The man did not complain of chest pain during the test. His blood pressure, which was expected to rise during the test, remained flat.

About 30 minutes after leaving the treadmill lab, the patient was found in full cardiac arrest at his desk at work. Paramedics were called, but he could not be resuscitated.

An autopsy revealed evidence of MI on the posterior portion of the heart, which corresponded with the complaints of chest pain about a week earlier. The decedent had 75% narrowing of the left anterior descending coronary artery, 75% narrowing of the right circumflex artery, and 30% narrowing of the right coronary artery. No thrombus or plaque rupture was identified. The cause of death was determined to be MI secondary to fatal arrhythmia, associated with coronary artery disease.

The plaintiffs claimed that Dr. C. should have included unstable angina in the differential diagnosis and should have assumed that the decedent had had a heart attack until proven otherwise. The plaintiffs claimed that the ECG taken in Dr. C.’s office was subtly abnormal and that the decedent should have been sent to a hospital immediately; there, they argued, blood would have been drawn and abnormal troponin levels detected. The plaintiffs claimed that the decedent would have then been sent to the catheterization lab for treatment—most likely, stenting.

The plaintiffs further claimed that Dr. W. took an inadequate history and that a treadmill test should not have been performed. The plaintiffs claimed that a myocardial perfusion test or nuclear imaging should have been performed. Further, the plaintiffs maintained that the ECG portion of the treadmill test had subtle abnormalities that Dr. W. overlooked, and that Dr. W. failed to appreciate the abnormality in the decedent’s blood pressure remaining flat during the test.

Dr. C. claimed that the decedent’s claims of chest pain at night suggested that the pain was not cardiac in origin. Dr. C. also claimed that he had acted reasonably in performing and interpreting the ECG. Dr. W. claimed that a treadmill stress test was appropriate for the decedent and that test results were normal.

The defendants both argued that the cause of death was not coronary artery disease, but coronary spasm. They maintained that there was only 50% narrowing in the coronary arteries and that the absence of thrombus or plaque rupture was inconsistent with a classic cardiac death resulting from coronary artery occlusion.

According to a published account, a defense verdict was returned for Dr. W. The jury was undecided in the case against Dr. C.

Obstetrician “Forgets” to Perform Tubal Ligation
A young woman in California became pregnant with her fourth child, although she was using birth control. During her prenatal care, she and her husband told the defendant obstetrician that they did not want, nor could they afford, any more children. They requested a bilateral tubal ligation at the time of a cesarean delivery, which was scheduled for a week before the projected due date.

The woman went into labor two days before the scheduled surgery. The prenatal records could not be found and the obstetrician’s office was closed. He delivered the baby by cesarean section but did not perform the tubal ligation. The mother was in the hospital for three days and was seen by the defendant for a six-week postpartum visit, but she claimed he never told her that he had not performed the tubal ligation. The mother did not take precautions to prevent pregnancy and subsequently conceived her fifth child. The plaintiffs did not opt to abort.

The plaintiffs alleged negligence and wrongful birth, contending that they were never told the tubal ligation had not been performed until after the fifth child was conceived.

The defendant claimed he told the mother at her six-week visit that the tubal ligation had not been performed and advised her to use birth control until she recovered from the cesarean delivery, when she could then undergo a tubal ligation. The obstetrician acknowledged that he had forgotten to perform the tubal ligation but insisted that there was no negligence involved.

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

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

Signs and Symptoms of Preeclampsia Repeatedly Overlooked
During her second pregnancy, a 23-year-old Michigan woman received prenatal care from Dr. L., beginning in April 2004. Her due date was December 2004.

In late November, the woman presented to a hospital emergency department (ED) with chest pain, cough, and shortness of breath. She was admitted with noted high blood pressure and tachycardia. During her hospitalization, the patient was examined by an emergency physician, who discharged her with a diagnosis of bronchitis and dyspnea.

Two days later, the patient returned to Dr. L. for a scheduled prenatal visit, at which time she still had high blood pressure. She was instructed to go to a second hospital; there, she was seen by a PA, who noted edema in her extremities. Attempts to draw blood for arterial blood gas analysis were unsuccessful, and crackles were noted throughout the woman’s lungs. An obstetrician/gynecologist, Dr. D., was contacted regarding worsening preeclampsia with pulmonary edema. It was decided to perform a cesarean delivery.

The woman became unresponsive on the way to surgery. After delivery, she experienced cardiopulmonary arrest and sustained an anoxic brain injury. She was declared brain dead and died after life support was withdrawn.

Upon autopsy, the cause of death was determined to be anoxic encephalopathy due to respiratory arrest caused by preeclampsia. The plaintiff claimed that Dr. L. failed to provide proper prenatal care and failed to recognize the signs and symptoms of preeclampsia, which the plaintiff alleged were evident in October. The plaintiff also claimed that the emergency physician at the first hospital failed to recognize the signs and symptoms of preeclampsia and failed to contact a specialist and to hospitalize the decedent immediately for monitoring and treatment.

As for the PA and Dr. D., the plaintiff claimed that they negligently administered a bolus of IV fluids when the decedent showed signs of preeclampsia, failed to administer proper dosages of furosemide, and failed to admit the decedent in a timely fashion.

The defendants all denied any negligence.

According to a published report, a $1.5 million settlement was reached.

No Action Taken on Abnormal Blood Cultures
Headache, fever, chills, vomiting, and wide-ranging muscle pain prompted an Indiana woman, age 44, to present to a hospital ED. She was examined by the defendant emergency physician, Dr. M., who ordered tests and made a diagnosis of influenza.

He ordered acetaminophen and prescription-strength ibuprofen and discharged the woman to home with instructions to consume copious amounts of fluid. Two days later, the laboratory staff contacted the ED by phone to report that the patient’s blood culture results were abnormal, indicating a possible bacterial infection. No one on the ED staff acted on this information.

Shortly before midnight the following evening, the patient returned to the ED complaining of similar symptoms. Based on the results of additional testing, acute renal failure and shock secondary to necrotizing soft tissue were diagnosed. The patient was transferred to another hospital, where she underwent extensive treatment, including several surgeries to remove infected tissue. The woman died, however, as a result of multiple organ failure and septic shock secondary to group A streptococcal infection.

The plaintiff alleged negligence by Dr. M. for his failure to investigate the possibility that the patient had a bacterial infection. The plaintiff also alleged negligence on the part of the ED personnel for their failure to act on the notification from the lab. The defendants denied any negligence.

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

Claim Heart Spasm, Not MI, After Treadmill Stress Test
A California man, age 51, saw his primary care physician and internist, Dr. C., and reported a 20-minute-long episode of chest pain in bed that morning. He also said he had had chest pain two mornings earlier, also in bed, that lasted longer than an hour. The patient had cardiac risk factors of obesity, hypertension, a history of smoking, and a strong family history of dyslipidemia and heart disease.

Dr. C. performed an ECG, with results interpreted as normal. He then prescribed a treadmill stress test, which was administered four days later by a cardiologist, Dr. W. The patient was able to complete the test, with his heart rate measured as high as 160 beats/min. Dr. W. interpreted the stress test as normal. The man did not complain of chest pain during the test. His blood pressure, which was expected to rise during the test, remained flat.

About 30 minutes after leaving the treadmill lab, the patient was found in full cardiac arrest at his desk at work. Paramedics were called, but he could not be resuscitated.

An autopsy revealed evidence of MI on the posterior portion of the heart, which corresponded with the complaints of chest pain about a week earlier. The decedent had 75% narrowing of the left anterior descending coronary artery, 75% narrowing of the right circumflex artery, and 30% narrowing of the right coronary artery. No thrombus or plaque rupture was identified. The cause of death was determined to be MI secondary to fatal arrhythmia, associated with coronary artery disease.

The plaintiffs claimed that Dr. C. should have included unstable angina in the differential diagnosis and should have assumed that the decedent had had a heart attack until proven otherwise. The plaintiffs claimed that the ECG taken in Dr. C.’s office was subtly abnormal and that the decedent should have been sent to a hospital immediately; there, they argued, blood would have been drawn and abnormal troponin levels detected. The plaintiffs claimed that the decedent would have then been sent to the catheterization lab for treatment—most likely, stenting.

The plaintiffs further claimed that Dr. W. took an inadequate history and that a treadmill test should not have been performed. The plaintiffs claimed that a myocardial perfusion test or nuclear imaging should have been performed. Further, the plaintiffs maintained that the ECG portion of the treadmill test had subtle abnormalities that Dr. W. overlooked, and that Dr. W. failed to appreciate the abnormality in the decedent’s blood pressure remaining flat during the test.

Dr. C. claimed that the decedent’s claims of chest pain at night suggested that the pain was not cardiac in origin. Dr. C. also claimed that he had acted reasonably in performing and interpreting the ECG. Dr. W. claimed that a treadmill stress test was appropriate for the decedent and that test results were normal.

The defendants both argued that the cause of death was not coronary artery disease, but coronary spasm. They maintained that there was only 50% narrowing in the coronary arteries and that the absence of thrombus or plaque rupture was inconsistent with a classic cardiac death resulting from coronary artery occlusion.

According to a published account, a defense verdict was returned for Dr. W. The jury was undecided in the case against Dr. C.

Obstetrician “Forgets” to Perform Tubal Ligation
A young woman in California became pregnant with her fourth child, although she was using birth control. During her prenatal care, she and her husband told the defendant obstetrician that they did not want, nor could they afford, any more children. They requested a bilateral tubal ligation at the time of a cesarean delivery, which was scheduled for a week before the projected due date.

The woman went into labor two days before the scheduled surgery. The prenatal records could not be found and the obstetrician’s office was closed. He delivered the baby by cesarean section but did not perform the tubal ligation. The mother was in the hospital for three days and was seen by the defendant for a six-week postpartum visit, but she claimed he never told her that he had not performed the tubal ligation. The mother did not take precautions to prevent pregnancy and subsequently conceived her fifth child. The plaintiffs did not opt to abort.

The plaintiffs alleged negligence and wrongful birth, contending that they were never told the tubal ligation had not been performed until after the fifth child was conceived.

The defendant claimed he told the mother at her six-week visit that the tubal ligation had not been performed and advised her to use birth control until she recovered from the cesarean delivery, when she could then undergo a tubal ligation. The obstetrician acknowledged that he had forgotten to perform the tubal ligation but insisted that there was no negligence involved.

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