Malpractice Chronicle

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

Ischemic Colitis Leads to Septic Shock 

A Massachusetts woman, age 59, presented to an emergency department (ED) with a week-long history of progressively worsening abdominal pain. She also complained of epigastric pain, left shoulder and breast pain, dizziness, nausea, and diarrhea. The emergency physician noted that her abdomen was soft, with diffuse tenderness to palpation. The patient was given 4.0 mg of morphine for pain. Laboratory studies revealed an elevated white blood cell count (16,200 cells/mL).

The patient’s blood pressure remained elevated and her pain persisted. She was given an additional 4.0 mg of morphine two-and-one-half hours after the initial dose. Nursing notes indicate that she was sitting on the edge of the stretcher, moaning with pain. An hour later, she was given a third dose of morphine.

Forty minutes later, the woman underwent abdominal CT, which revealed diverticulosis. The patient continued to complain of severe abdominal pain, which relented somewhat after acetaminophen was administered. She was discharged home with instructions to return to the ED in the event of worsening pain, fever, or other concerns; otherwise, she should follow up with her primary care physician the following day.

The woman returned to the ED the next day with continuing severe abdominal pain. She was determined to be experiencing septic shock at that time. She underwent abdominal/pelvic CT, which revealed new development of several areas of free air within the peritoneal cavity, compared with the previous study. She was immediately taken to surgery and was found to have gangrene of the small bowel and perforation of the cecum, with free stool in the area. Resection of the small bowel was performed. The woman remained acidotic with low blood pressure despite various interventions. She went into cardiac arrest and died of septic shock secondary to ischemic colitis.

The plaintiff claimed that the radiologist who reviewed the first abdominal CT failed to identify and report findings of impaired blood flow on the later abdominal/pelvic CT and failed to recommend an urgent surgical consultation.

The radiologist contended that the CT did not show evidence of impaired blood flow.

A $1.5 million settlement was reached.

Failure to Contact Patient With Pathology Results

An Illinois woman, age 31, presented to the defendant dermatologist, Dr. K., in September 2002 with concerns about a mole. The dermatologist thought the mole in question was of no concern but recommended removal of a second mole on the back of her arm. After removing that mole in December 2002, Dr. K. scheduled a return visit in two weeks to assess the healing of the area, remove the sutures, review the pathology results, and discuss further plans.

The patient did not keep the scheduled appointment because she thought she was returning simply to have the stitches removed, and they had already fallen out. The pathology report indicated some architectural disorder with one peripheral margin involved and suggested a further wide excision in the area of the removed mole, with histologic tissue analysis and definitive diagnosis. Neither Dr. K. nor his office staff made any attempt to contact the patient to urge her to come in or to inform her of the pathology results.

The patient later returned to Dr. K.’s office to be seen for acne, but saw a physician assistant instead.

Three years after her procedure, the patient developed melanoma near the site of the mole removal. During a wide excision procedure she underwent in September 2005, a residual melanoma was found. A sentinel lymph node biopsy was also performed. Results were negative, but hypertrophic scarring resulted. At several visits since that time, no additional melanoma has been found.

The plaintiff claimed that the diagnosis of melanoma caused substantial alteration of her lifestyle and a personality change. She claimed that the original arm lesion the defendant removed was premalignant and that he had a duty to contact her, explain the pathology result, and recommend that she return for a wide excision.

The defendant claimed that the lesion he removed was benign, that there was no duty to contact the plaintiff regarding a benign pathology report, and that the proper recommendation would be to watch the area and return if any problems developed. The defendant further claimed that it could not be determined with certainty whether the melanoma evolved from a microscopic portion of the mole or was a new development. The defendant claimed that the plaintiff needed to alter her lifestyle and protect herself from the sun in any event because she had a biogenetic predisposition for melanoma. She was also at future risk for developing new melanomas, unrelated to his treatment.

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

Infant’s Bacterial Infection Missed

The plaintiff child, age 20 months, was brought to the emergency department (ED) with trouble breathing and a low-grade fever. The emergency physician, Dr. S., made a diagnosis of viral croup and discharged her.

The next day, the girl was brought back to the ED, where she was seen by a second emergency physician, Dr. G. Her temperature had risen to 106°F, and she had developed a croupy cough. Following administration of acetaminophen and other medications, the child’s temperature was reduced to 100°F. A test for streptococcal infection yielded negative results, and the infant was discharged.

The infant did well the following day, but that night her parents noticed that she was lethargic and breathing with difficulty. She was taken to the ED again and seen by Dr. G. This time, a diagnosis of pneumonia was quickly made, and the patient was transferred to a children’s hospital.

The child died that evening. Autopsy revealed group A streptococcal infection, which had led to toxic shock syndrome.

The plaintiff claimed that Dr. G. was negligent in his failure to diagnose the infection and to begin antibiotics when he first saw the infant. The plaintiffs claimed that the medications used included steroids, which suppressed the child’s immune system, making it more difficult for her to fight infection.

Dr. G. claimed that the infant’s presentation was inconsistent with a bacterial infection and that his diagnosis was reasonable. The defendant also claimed that the infant had an infection that would not have responded to antibiotics.

A defense verdict was returned.

Change of Procedure, Surgical Instrument Retained

In New York City, a 54-year-old man underwent a sleeve gastrectomy, performed by Dr. M. and Dr. S. Three days later, the patient was informed that a surgical tool had been left in his body, and he returned to the hospital.

CT revealed no foreign object. The patient’s large size made MRI impossible, and he was discharged. The man died three days later of peritonitis, which the plaintiff for the decedent claimed resulted from damage inflicted by a surgical instrument that had not been removed. The plaintiff claimed that the patient had consented to a Roux-en-Y bypass and had undergone presurgical preparation for that procedure, but that plan was abandoned shortly before the surgery. The plaintiff claimed that the problems resulting from the surgery performed were related to the procedure itself—specifically, that the cutting and stapling tool used in the gastrectomy had severed the esophageal stethoscope used, after which the severed remnant of the stethoscope was inadvertently stapled into the patient’s stomach.

The plaintiff for the decedent claimed that the remnant caused leakage of bile, which led to fatal peritonitis. The plaintiff claimed that the surgeons should not have concluded the surgery until it was confirmed that the stomach was properly sealed. The plaintiff also claimed that the defendants failed to address the decedent’s postsurgical symptoms of fever and severe pain.

The defendants countered that the decedent had reported no such symptoms and that there were no indications of infection. The defendants also claimed that neither CT nor intraoperative testing revealed any leakage in the decedent’s stomach. The defendants claimed that the decedent had signed a consent to undergo a gastrectomy, and that a gastrectomy had always been the intended procedure. The defendants additionally claimed that the foreign object in question was a probe, which the anesthesiologist inserted to measure the patient’s esophageal temperature without the surgeons’ knowledge.

According to a published account, a settlement of $675,000 was reached.

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

Ischemic Colitis Leads to Septic Shock 

A Massachusetts woman, age 59, presented to an emergency department (ED) with a week-long history of progressively worsening abdominal pain. She also complained of epigastric pain, left shoulder and breast pain, dizziness, nausea, and diarrhea. The emergency physician noted that her abdomen was soft, with diffuse tenderness to palpation. The patient was given 4.0 mg of morphine for pain. Laboratory studies revealed an elevated white blood cell count (16,200 cells/mL).

The patient’s blood pressure remained elevated and her pain persisted. She was given an additional 4.0 mg of morphine two-and-one-half hours after the initial dose. Nursing notes indicate that she was sitting on the edge of the stretcher, moaning with pain. An hour later, she was given a third dose of morphine.

Forty minutes later, the woman underwent abdominal CT, which revealed diverticulosis. The patient continued to complain of severe abdominal pain, which relented somewhat after acetaminophen was administered. She was discharged home with instructions to return to the ED in the event of worsening pain, fever, or other concerns; otherwise, she should follow up with her primary care physician the following day.

The woman returned to the ED the next day with continuing severe abdominal pain. She was determined to be experiencing septic shock at that time. She underwent abdominal/pelvic CT, which revealed new development of several areas of free air within the peritoneal cavity, compared with the previous study. She was immediately taken to surgery and was found to have gangrene of the small bowel and perforation of the cecum, with free stool in the area. Resection of the small bowel was performed. The woman remained acidotic with low blood pressure despite various interventions. She went into cardiac arrest and died of septic shock secondary to ischemic colitis.

The plaintiff claimed that the radiologist who reviewed the first abdominal CT failed to identify and report findings of impaired blood flow on the later abdominal/pelvic CT and failed to recommend an urgent surgical consultation.

The radiologist contended that the CT did not show evidence of impaired blood flow.

A $1.5 million settlement was reached.

Failure to Contact Patient With Pathology Results

An Illinois woman, age 31, presented to the defendant dermatologist, Dr. K., in September 2002 with concerns about a mole. The dermatologist thought the mole in question was of no concern but recommended removal of a second mole on the back of her arm. After removing that mole in December 2002, Dr. K. scheduled a return visit in two weeks to assess the healing of the area, remove the sutures, review the pathology results, and discuss further plans.

The patient did not keep the scheduled appointment because she thought she was returning simply to have the stitches removed, and they had already fallen out. The pathology report indicated some architectural disorder with one peripheral margin involved and suggested a further wide excision in the area of the removed mole, with histologic tissue analysis and definitive diagnosis. Neither Dr. K. nor his office staff made any attempt to contact the patient to urge her to come in or to inform her of the pathology results.

The patient later returned to Dr. K.’s office to be seen for acne, but saw a physician assistant instead.

Three years after her procedure, the patient developed melanoma near the site of the mole removal. During a wide excision procedure she underwent in September 2005, a residual melanoma was found. A sentinel lymph node biopsy was also performed. Results were negative, but hypertrophic scarring resulted. At several visits since that time, no additional melanoma has been found.

The plaintiff claimed that the diagnosis of melanoma caused substantial alteration of her lifestyle and a personality change. She claimed that the original arm lesion the defendant removed was premalignant and that he had a duty to contact her, explain the pathology result, and recommend that she return for a wide excision.

The defendant claimed that the lesion he removed was benign, that there was no duty to contact the plaintiff regarding a benign pathology report, and that the proper recommendation would be to watch the area and return if any problems developed. The defendant further claimed that it could not be determined with certainty whether the melanoma evolved from a microscopic portion of the mole or was a new development. The defendant claimed that the plaintiff needed to alter her lifestyle and protect herself from the sun in any event because she had a biogenetic predisposition for melanoma. She was also at future risk for developing new melanomas, unrelated to his treatment.

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

Infant’s Bacterial Infection Missed

The plaintiff child, age 20 months, was brought to the emergency department (ED) with trouble breathing and a low-grade fever. The emergency physician, Dr. S., made a diagnosis of viral croup and discharged her.

The next day, the girl was brought back to the ED, where she was seen by a second emergency physician, Dr. G. Her temperature had risen to 106°F, and she had developed a croupy cough. Following administration of acetaminophen and other medications, the child’s temperature was reduced to 100°F. A test for streptococcal infection yielded negative results, and the infant was discharged.

The infant did well the following day, but that night her parents noticed that she was lethargic and breathing with difficulty. She was taken to the ED again and seen by Dr. G. This time, a diagnosis of pneumonia was quickly made, and the patient was transferred to a children’s hospital.

The child died that evening. Autopsy revealed group A streptococcal infection, which had led to toxic shock syndrome.

The plaintiff claimed that Dr. G. was negligent in his failure to diagnose the infection and to begin antibiotics when he first saw the infant. The plaintiffs claimed that the medications used included steroids, which suppressed the child’s immune system, making it more difficult for her to fight infection.

Dr. G. claimed that the infant’s presentation was inconsistent with a bacterial infection and that his diagnosis was reasonable. The defendant also claimed that the infant had an infection that would not have responded to antibiotics.

A defense verdict was returned.

Change of Procedure, Surgical Instrument Retained

In New York City, a 54-year-old man underwent a sleeve gastrectomy, performed by Dr. M. and Dr. S. Three days later, the patient was informed that a surgical tool had been left in his body, and he returned to the hospital.

CT revealed no foreign object. The patient’s large size made MRI impossible, and he was discharged. The man died three days later of peritonitis, which the plaintiff for the decedent claimed resulted from damage inflicted by a surgical instrument that had not been removed. The plaintiff claimed that the patient had consented to a Roux-en-Y bypass and had undergone presurgical preparation for that procedure, but that plan was abandoned shortly before the surgery. The plaintiff claimed that the problems resulting from the surgery performed were related to the procedure itself—specifically, that the cutting and stapling tool used in the gastrectomy had severed the esophageal stethoscope used, after which the severed remnant of the stethoscope was inadvertently stapled into the patient’s stomach.

The plaintiff for the decedent claimed that the remnant caused leakage of bile, which led to fatal peritonitis. The plaintiff claimed that the surgeons should not have concluded the surgery until it was confirmed that the stomach was properly sealed. The plaintiff also claimed that the defendants failed to address the decedent’s postsurgical symptoms of fever and severe pain.

The defendants countered that the decedent had reported no such symptoms and that there were no indications of infection. The defendants also claimed that neither CT nor intraoperative testing revealed any leakage in the decedent’s stomach. The defendants claimed that the decedent had signed a consent to undergo a gastrectomy, and that a gastrectomy had always been the intended procedure. The defendants additionally claimed that the foreign object in question was a probe, which the anesthesiologist inserted to measure the patient’s esophageal temperature without the surgeons’ knowledge.

According to a published account, a settlement of $675,000 was reached.

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

Ischemic Colitis Leads to Septic Shock 

A Massachusetts woman, age 59, presented to an emergency department (ED) with a week-long history of progressively worsening abdominal pain. She also complained of epigastric pain, left shoulder and breast pain, dizziness, nausea, and diarrhea. The emergency physician noted that her abdomen was soft, with diffuse tenderness to palpation. The patient was given 4.0 mg of morphine for pain. Laboratory studies revealed an elevated white blood cell count (16,200 cells/mL).

The patient’s blood pressure remained elevated and her pain persisted. She was given an additional 4.0 mg of morphine two-and-one-half hours after the initial dose. Nursing notes indicate that she was sitting on the edge of the stretcher, moaning with pain. An hour later, she was given a third dose of morphine.

Forty minutes later, the woman underwent abdominal CT, which revealed diverticulosis. The patient continued to complain of severe abdominal pain, which relented somewhat after acetaminophen was administered. She was discharged home with instructions to return to the ED in the event of worsening pain, fever, or other concerns; otherwise, she should follow up with her primary care physician the following day.

The woman returned to the ED the next day with continuing severe abdominal pain. She was determined to be experiencing septic shock at that time. She underwent abdominal/pelvic CT, which revealed new development of several areas of free air within the peritoneal cavity, compared with the previous study. She was immediately taken to surgery and was found to have gangrene of the small bowel and perforation of the cecum, with free stool in the area. Resection of the small bowel was performed. The woman remained acidotic with low blood pressure despite various interventions. She went into cardiac arrest and died of septic shock secondary to ischemic colitis.

The plaintiff claimed that the radiologist who reviewed the first abdominal CT failed to identify and report findings of impaired blood flow on the later abdominal/pelvic CT and failed to recommend an urgent surgical consultation.

The radiologist contended that the CT did not show evidence of impaired blood flow.

A $1.5 million settlement was reached.

Failure to Contact Patient With Pathology Results

An Illinois woman, age 31, presented to the defendant dermatologist, Dr. K., in September 2002 with concerns about a mole. The dermatologist thought the mole in question was of no concern but recommended removal of a second mole on the back of her arm. After removing that mole in December 2002, Dr. K. scheduled a return visit in two weeks to assess the healing of the area, remove the sutures, review the pathology results, and discuss further plans.

The patient did not keep the scheduled appointment because she thought she was returning simply to have the stitches removed, and they had already fallen out. The pathology report indicated some architectural disorder with one peripheral margin involved and suggested a further wide excision in the area of the removed mole, with histologic tissue analysis and definitive diagnosis. Neither Dr. K. nor his office staff made any attempt to contact the patient to urge her to come in or to inform her of the pathology results.

The patient later returned to Dr. K.’s office to be seen for acne, but saw a physician assistant instead.

Three years after her procedure, the patient developed melanoma near the site of the mole removal. During a wide excision procedure she underwent in September 2005, a residual melanoma was found. A sentinel lymph node biopsy was also performed. Results were negative, but hypertrophic scarring resulted. At several visits since that time, no additional melanoma has been found.

The plaintiff claimed that the diagnosis of melanoma caused substantial alteration of her lifestyle and a personality change. She claimed that the original arm lesion the defendant removed was premalignant and that he had a duty to contact her, explain the pathology result, and recommend that she return for a wide excision.

The defendant claimed that the lesion he removed was benign, that there was no duty to contact the plaintiff regarding a benign pathology report, and that the proper recommendation would be to watch the area and return if any problems developed. The defendant further claimed that it could not be determined with certainty whether the melanoma evolved from a microscopic portion of the mole or was a new development. The defendant claimed that the plaintiff needed to alter her lifestyle and protect herself from the sun in any event because she had a biogenetic predisposition for melanoma. She was also at future risk for developing new melanomas, unrelated to his treatment.

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

Infant’s Bacterial Infection Missed

The plaintiff child, age 20 months, was brought to the emergency department (ED) with trouble breathing and a low-grade fever. The emergency physician, Dr. S., made a diagnosis of viral croup and discharged her.

The next day, the girl was brought back to the ED, where she was seen by a second emergency physician, Dr. G. Her temperature had risen to 106°F, and she had developed a croupy cough. Following administration of acetaminophen and other medications, the child’s temperature was reduced to 100°F. A test for streptococcal infection yielded negative results, and the infant was discharged.

The infant did well the following day, but that night her parents noticed that she was lethargic and breathing with difficulty. She was taken to the ED again and seen by Dr. G. This time, a diagnosis of pneumonia was quickly made, and the patient was transferred to a children’s hospital.

The child died that evening. Autopsy revealed group A streptococcal infection, which had led to toxic shock syndrome.

The plaintiff claimed that Dr. G. was negligent in his failure to diagnose the infection and to begin antibiotics when he first saw the infant. The plaintiffs claimed that the medications used included steroids, which suppressed the child’s immune system, making it more difficult for her to fight infection.

Dr. G. claimed that the infant’s presentation was inconsistent with a bacterial infection and that his diagnosis was reasonable. The defendant also claimed that the infant had an infection that would not have responded to antibiotics.

A defense verdict was returned.

Change of Procedure, Surgical Instrument Retained

In New York City, a 54-year-old man underwent a sleeve gastrectomy, performed by Dr. M. and Dr. S. Three days later, the patient was informed that a surgical tool had been left in his body, and he returned to the hospital.

CT revealed no foreign object. The patient’s large size made MRI impossible, and he was discharged. The man died three days later of peritonitis, which the plaintiff for the decedent claimed resulted from damage inflicted by a surgical instrument that had not been removed. The plaintiff claimed that the patient had consented to a Roux-en-Y bypass and had undergone presurgical preparation for that procedure, but that plan was abandoned shortly before the surgery. The plaintiff claimed that the problems resulting from the surgery performed were related to the procedure itself—specifically, that the cutting and stapling tool used in the gastrectomy had severed the esophageal stethoscope used, after which the severed remnant of the stethoscope was inadvertently stapled into the patient’s stomach.

The plaintiff for the decedent claimed that the remnant caused leakage of bile, which led to fatal peritonitis. The plaintiff claimed that the surgeons should not have concluded the surgery until it was confirmed that the stomach was properly sealed. The plaintiff also claimed that the defendants failed to address the decedent’s postsurgical symptoms of fever and severe pain.

The defendants countered that the decedent had reported no such symptoms and that there were no indications of infection. The defendants also claimed that neither CT nor intraoperative testing revealed any leakage in the decedent’s stomach. The defendants claimed that the decedent had signed a consent to undergo a gastrectomy, and that a gastrectomy had always been the intended procedure. The defendants additionally claimed that the foreign object in question was a probe, which the anesthesiologist inserted to measure the patient’s esophageal temperature without the surgeons’ knowledge.

According to a published account, a settlement of $675,000 was reached.