Malpractice Chronicle

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

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

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

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.

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

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

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

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.

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

Perforation During “Unnecessary” Procedure
A Wyoming man in his mid-30s began to experience back and abdominal pain, apparently related to a previous surgery. The patient was seen by defendant Dr. A., who performed an upper endoscopy that revealed no abnormalities. Three days later, Dr. A. performed an endoscopic retrograde cholangiopancreatography and biliary sphincterotomy.

Apparently, a perforation of the duodenum occurred during the latter procedure, resulting in a leakage of fluids into the abdominal cavity and causing the patient to become critically ill. He returned to the hospital the next day and was seen again by Dr. A., who failed to diagnose or treat the perforation. Once a diagnosis was made, the plaintiff gave consent for defendant Dr. B. to perform a duodenal diverticulization, but instead, she performed a duodenotomy, pyloric exclusion, and gastrojejunostomy.

The plaintiff claimed that both the follow-up procedures performed by Dr. A. and the pyloric exclusion and the gastrojejunostomy performed by Dr. B. were unnecessary. The plaintiff claimed that Dr. A. was responsible for perforation of the duodenum, and that during the procedures performed by Dr. B., the duodenum reopened, again leaking fluids into his abdominal cavity.

Dr. C. took over for Dr. B. and performed five additional surgeries, all of which the plaintiff alleged were unnecessary and further complicated his recovery. The plaintiff was finally transferred to another facility—but not soon enough, he claimed. The plaintiff’s stomach has now been substantially reconstructed with a special mesh that restricts him in movement, lifting, and prospects for employment.

The defendants each denied any negligence.

According to a published account, a $1.87 million verdict was returned, with Dr. A. found 60% at fault and Dr. B. found 40% at fault. Dr. C. was found not liable. The verdict included an award of $380,000 to the federal government for past medical expenses as the patient was serving in the armed forces at the time of his initial surgery.

Inconsistent Reading of Chest X-Rays
An Ohio woman, age 67, was diagnosed with non–small cell lung cancer. Her cancer progressed over a 20-month period from curable to incurable. At the time of settlement, she had stage IV lung cancer with only a 10% to 20% chance of surviving five years.

Defendant Dr. L., the woman’s primary care physician, had ordered chest x-rays on two occasions. Each revealed findings suggestive of a pulmonary mass in the left lower lobe of her lung. The first chest x-ray was properly read by a radiologist, who recommended follow-up in six to eight weeks. Dr. L. did nothing, disregarding this recommendation.

When the second chest x-ray was performed 11 months later, a different radiologist failed to detect an increase in the mass in the left lower lobe of the lung and incorrectly interpreted this chest x-ray. A third chest x-ray performed during an emergency department (ED) evaluation for the complaint of chest pain revealed a 3.0-cm mass in the patient’s left lung. The mass was appropriately investigated and treated, but the cancer had metastasized and was eventually confirmed to involve the peribronchial lymph nodes, the pleura, and the right femur. The woman was confirmed to have moderately differentiated adenocarcinoma.

She underwent surgical resection of the lung cancer with five cycles of chemotherapy. This was followed by salvage chemotherapy, which placed her in remission. A $700,000 settlement was reached.

Investigation Inadequate for Blackouts
At age 37, an obese woman in Illinois had a complicated medical history, including a tonsillectomy and adenoidectomy, bleeding ulcers, hypertension, and a left-lobe thyroidectomy. In March, she began to experience blackouts, during which she often collapsed.

Her primary care physician hospitalized her for diagnostic testing, but all results were normal. When the patient’s blackouts continued, she was referred to the defendant neurologist, Dr. F., for evaluation. She was in Dr. F.’s care from May to June, when she was also being seen by the defendant Dr. G. for treatment of chronic back pain. This involved multiple medications, including rofecoxib (a COX-2 inhibitor that was voluntarily withdrawn from the market in 2005).

Dr. F. ordered an echocardiogram, an electroencephalogram, and Holter monitoring to rule out cardiac and neurologic causes. She also prescribed the anticonvulsant divalproex sodium. At the patient’s last visit with Dr. F., the neurologist ordered a gradual increase of divalproex from 500 mg/d to 1500 mg/d.

Three days later, the patient died in her sleep. She was found with blood coming from her nose and on the bedding. At the time of death, blood was also found in her stomach. The coroner listed the cause of death as cardiac arrhythmia secondary to atherosclerotic heart disease; this was thought to have been precipitated by an acute hemorrhagic gastritis attributed to rofecoxib therapy. There was no evidence of a blood clot or heart attack.

The plaintiff claimed that the decedent had experienced more than two dozen blackouts before she died and that she should have been hospitalized by Dr. F. until their cause was determined. The plaintiff also claimed that the decedent should have been evaluated for obstructive sleep apnea, claiming that the patient’s death was caused by sleep apnea coupled with the effects of prescribed central nervous system depressants. These, the plaintiff claimed, prevented the decedent from clearing her airway of the blood attributed to her rofecoxib use.

The defendants claimed that a work-up for sleep apnea was not indicated. The defendants claimed that the woman died as a result of a primary cardiac arrhythmia.

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

Failure to Remove Pacemaker for Heart Infection
In August 2003, a 58-year-old woman underwent implantation of a pacemaker by the defendant cardiologist at a Michigan hospital. The patient was discharged under the care of a visiting nurse service.

A week after her surgery, the woman presented to the hospital’s ED with bloody drainage from the surgical wound. Her cardiologist ruled out bacteremia, sepsis, an abscess, and a pacemaker pocket infection. Consultation with an internist and infectious disease specialist led to a recommendation that cultures be taken of the pacemaker site and the pocket drainage to rule out a deep pocket infection or infected hematoma. No cultures were taken, however, and the patient was discharged after four days with a 12-day prescription for vancomycin; but the infectious disease specialist discontinued the order for antibiotics after seven days, and the patient’s condition began to decline.

In late August, she was evaluated by the cardiologist, who performed a second surgery in late September. Upon finding a large hematoma in the pacemaker pocket, he revised the pocket, removed the hematoma, rinsed the pocket with an antibiotic solution, and closed the surgical wound without removing the pacemaker.

The woman was discharged the following day with orders for cephalexin, doxycycline, and clonidine, but she was given no prescriptions. Although a visiting nurse reportedly contacted the cardiologist for prescriptions, he provided them for doxycycline and clonidine only.

The patient returned to the ED in early November with complaints of neck pain and vomiting. She was given a diagnosis of pyelonephritis and dehydration. Three days later, she experienced a neurologic collapse, after which it was determined that she had a heart infection with vegetation on the heart valves. She died nine days later. An autopsy confirmed her death as resulting from septic embolic infarct and bacterial endocarditis.

The plaintiff claimed that the decedent’s pacemaker should have been removed during the second surgery, that proper antibiotic therapy should have been prescribed, and that the decedent should have been hospitalized in late August for diagnostic testing. The defendant denied any negligence.

According to a published report, a $145,000 settlement was reached.