Malpractice Chronicle

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

Volvulus Missed in Gastric Bypass Patient
A 37-year-old woman presented to an emergency department (ED) in Kentucky with nausea and vomiting. The defendant emergency physician noted a soft abdomen. The woman’s vital signs were mostly normal; fluids were administered, and she was discharged with instructions that included an admonition to return if her symptoms worsened. 

The emergency physician had previously seen the patient several times in the ED for various complaints. In the previous three years, she had experienced weakness and other symptoms after successful gastric bypass, as a result of which her weight had dropped from 300 to 93 lb.

The woman returned to the ED that evening. It was claimed that the emergency physician was indifferent and dismissive, and that in one exchange, asked her, “What am I supposed to do for you?” The patient replied, “I’m not a doctor, I don’t know.”

The patient’s symptoms were unchanged, but her vital signs were stable. The emergency physician suggested blood work, which the woman refused. She was released that night with a prescription for pain medication and spent most of the following day in bed. She died during the night.

An autopsy revealed a volvulus of the jejunum, which had caused a fatal septic event. The plaintiff claimed that CT should have been performed, as it would have led to detection of the volvulus. The emergency physician claimed that CT was not required, based on the decedent’s presentation. The defendant hospital denied any negligence, arguing that the emergency physician was not an employee.

According to a published account, $2,192,000 was awarded against both defendants.

Too Little Testing, Too Little Follow-Up
In May 2004, a 49-year-old man went to defendant Dr. D.’s office in Pennsylvania for a physical examination. At this visit, the patient complained of muscle aches, joint pain, fatigue, impotence, and other symptoms. No laboratory tests were ordered.

In October 2005, the patient returned to Dr. D. with the same symptoms and a weight loss of 40 lb. Blood work was ordered at that time, which it was later claimed revealed hematologic abnormalities. Recorded findings included elevated levels of triglycerides (500 mg/dL) and total cholesterol (205 mg/dL), a low HDL cholesterol level (30 mg/dL), elevated blood glucose (308 mg/dL), and a low platelet count (63,000/L). The man’s alkaline phosphatase level was also elevated (172 U/L). No follow-up took place.

Later that month, the patient returned to Dr. D. complaining of persistent symptoms. At that time, Dr. D. suggested that results of an ECG the man had undergone were abnormal. However, Dr. D. still did not follow up on abnormalities in the patient’s blood work.

Early in January 2006, the patient contacted Dr. D. and reported that he was experiencing constant nausea, headaches, and decreased urination. Dr. D. instructed him to go to the ED. There, a chest x-ray revealed pulmonary vascular congestion, bilateral pulmonary effusions, and splenomegaly. Heart studies showed heart dysfunction, and blood test results indicated abnormal liver function.

Four days later, the man was transferred to another hospital for placement of an intra-aortic balloon pump. He died the following day as a result of undiagnosed and untreated hemochromatosis, which had led to multisystem organ failure.

The plaintiff claimed that Dr. D. failed to order blood work to rule out or confirm hemochromatosis or other medical conditions at the decedent’s first visit. The plaintiff claimed that Dr. D. was negligent in failing to follow up on the decedent’s complaints and later on his abnormal test results.

The defendant maintained that the decedent’s liver test results were normal and that his other health issues had given the defendant no reason to refer the man to a hematologist.

A defense verdict was reportedly returned.

Man With Aortic Occlusion Requests Transfer
A 59-year-old Illinois man awoke one morning experiencing back pain and the inability to move his legs. Paramedics responded and transported him to a hospital, where he was examined by Dr. E., an emergency physician. Dr. E. found normal vital signs, diminished lung sounds, no detectable pulses in the man’s legs, and mottled feet.

In consideration of the patient’s diabetic neuropathy, abdominal CT was performed without contrast dye; it did not reveal an abdominal aortic aneurysm, but it did show a large pleural effusion on both sides. Dr. E. believed there was a mass in the left lower lobe and suspected that aortic disease was present.

A vascular surgeon, Dr. V., was consulted regarding concerns of a possible occluded or dissecting aorta. Dr. V. found Doppler pulses in the groin and felt a faint femoral pulse on the left side. Dr. V. believed that there was an occluded aorta, but due to effusion in the chest, as well as the patient’s history of smoking, hemoptysis, weight loss, and acute-onset paralysis, Dr. V. also suspected a malignancy with spinal cord involvement.

A consulting neurosurgeon recommended an MRI of the spinal cord, and Dr. E. and Dr. V. agreed. A stat MRI could not be performed at this facility during overnight hours, so the patient was transferred to another hospital for the MRI and magnetic resonance angiography (MRA). Before the transfer, Dr. V. performed a thoracentesis in which 3,000 cc of fluid was drained.

The patient was gone from the hospital for a little longer than four hours. The MRI did not reveal any spinal cord compression, but the MRA showed complete occlusion of the abdominal aorta below the renal arteries. Dr. V. was informed of the results during a phone conversation with the radiologist.

When the patient was returned to the hospital, attempts were made to contact Dr. V., but Dr. V. never received those calls. Dr. V. returned to the ED after the patient had been there for about 40 minutes and told him that he needed immediate surgery. The patient, a veteran, requested that he be transferred to the VA hospital where his records were maintained. Heparin was administered and he was transferred to the VA hospital, accompanied by a nurse.

Upon the man’s arrival at the VA hospital, a surgical resident assessed his prognosis as poor, with or without surgical exploration. The patient’s wife called the ED a few hours later and requested that no intervention be performed until her arrival at the VA hospital.

When the family arrived there about three hours later, the vascular surgery chief resident advised them that the man’s prognosis was certain death with no intervention, and an 80% to 90% probability of death with thrombectomy/revascularization. The family agreed to surgery, which was begun more than 12 hours after the MRA was performed. The surgery, which included bilateral groin exploration, aortic thrombectomy, and bilateral fasciotomy, was completed after five hours with no complications.

The patient’s condition began to deteriorate two days later. CT revealed left parietal and right temporal hemispheric stroke. After further deterioration, the family requested DNR status, and the man died.

The plaintiff alleged negligence in the failure to timely diagnose and treat the aortic occlusion and in negligently allowing transfer to a VA hospital despite the decedent’s emergent and unstable condition. The defendants claimed that the decedent’s vital signs were stable throughout his care before transfer to the VA and that he was always alert and oriented.

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

Did Missed Orbital Fracture Lead to Nerve Impingement?
During a softball game, a 35-year-old New Jersey man was struck in the eye by a line drive. He went to a medical center ED where he was seen by an emergency physician. The physician did not order CT and, according to the patient, failed to diagnose a fractured orbit.

The man later developed an impinged infraorbital nerve as a result of untreated bone fragments, which allegedly resulted in permanent complications of the underlying injury. He claimed that CT was required, given the nature of the injury, because it would have revealed the fracture, allowing for timely treatment. The defendant maintained that CT was not necessary.

The jury found the physician negligent and also found that the physician’s negligence was the proximate cause of the plaintiff’s condition. The plaintiff received a $240,000 judgment.

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

Volvulus Missed in Gastric Bypass Patient
A 37-year-old woman presented to an emergency department (ED) in Kentucky with nausea and vomiting. The defendant emergency physician noted a soft abdomen. The woman’s vital signs were mostly normal; fluids were administered, and she was discharged with instructions that included an admonition to return if her symptoms worsened. 

The emergency physician had previously seen the patient several times in the ED for various complaints. In the previous three years, she had experienced weakness and other symptoms after successful gastric bypass, as a result of which her weight had dropped from 300 to 93 lb.

The woman returned to the ED that evening. It was claimed that the emergency physician was indifferent and dismissive, and that in one exchange, asked her, “What am I supposed to do for you?” The patient replied, “I’m not a doctor, I don’t know.”

The patient’s symptoms were unchanged, but her vital signs were stable. The emergency physician suggested blood work, which the woman refused. She was released that night with a prescription for pain medication and spent most of the following day in bed. She died during the night.

An autopsy revealed a volvulus of the jejunum, which had caused a fatal septic event. The plaintiff claimed that CT should have been performed, as it would have led to detection of the volvulus. The emergency physician claimed that CT was not required, based on the decedent’s presentation. The defendant hospital denied any negligence, arguing that the emergency physician was not an employee.

According to a published account, $2,192,000 was awarded against both defendants.

Too Little Testing, Too Little Follow-Up
In May 2004, a 49-year-old man went to defendant Dr. D.’s office in Pennsylvania for a physical examination. At this visit, the patient complained of muscle aches, joint pain, fatigue, impotence, and other symptoms. No laboratory tests were ordered.

In October 2005, the patient returned to Dr. D. with the same symptoms and a weight loss of 40 lb. Blood work was ordered at that time, which it was later claimed revealed hematologic abnormalities. Recorded findings included elevated levels of triglycerides (500 mg/dL) and total cholesterol (205 mg/dL), a low HDL cholesterol level (30 mg/dL), elevated blood glucose (308 mg/dL), and a low platelet count (63,000/L). The man’s alkaline phosphatase level was also elevated (172 U/L). No follow-up took place.

Later that month, the patient returned to Dr. D. complaining of persistent symptoms. At that time, Dr. D. suggested that results of an ECG the man had undergone were abnormal. However, Dr. D. still did not follow up on abnormalities in the patient’s blood work.

Early in January 2006, the patient contacted Dr. D. and reported that he was experiencing constant nausea, headaches, and decreased urination. Dr. D. instructed him to go to the ED. There, a chest x-ray revealed pulmonary vascular congestion, bilateral pulmonary effusions, and splenomegaly. Heart studies showed heart dysfunction, and blood test results indicated abnormal liver function.

Four days later, the man was transferred to another hospital for placement of an intra-aortic balloon pump. He died the following day as a result of undiagnosed and untreated hemochromatosis, which had led to multisystem organ failure.

The plaintiff claimed that Dr. D. failed to order blood work to rule out or confirm hemochromatosis or other medical conditions at the decedent’s first visit. The plaintiff claimed that Dr. D. was negligent in failing to follow up on the decedent’s complaints and later on his abnormal test results.

The defendant maintained that the decedent’s liver test results were normal and that his other health issues had given the defendant no reason to refer the man to a hematologist.

A defense verdict was reportedly returned.

Man With Aortic Occlusion Requests Transfer
A 59-year-old Illinois man awoke one morning experiencing back pain and the inability to move his legs. Paramedics responded and transported him to a hospital, where he was examined by Dr. E., an emergency physician. Dr. E. found normal vital signs, diminished lung sounds, no detectable pulses in the man’s legs, and mottled feet.

In consideration of the patient’s diabetic neuropathy, abdominal CT was performed without contrast dye; it did not reveal an abdominal aortic aneurysm, but it did show a large pleural effusion on both sides. Dr. E. believed there was a mass in the left lower lobe and suspected that aortic disease was present.

A vascular surgeon, Dr. V., was consulted regarding concerns of a possible occluded or dissecting aorta. Dr. V. found Doppler pulses in the groin and felt a faint femoral pulse on the left side. Dr. V. believed that there was an occluded aorta, but due to effusion in the chest, as well as the patient’s history of smoking, hemoptysis, weight loss, and acute-onset paralysis, Dr. V. also suspected a malignancy with spinal cord involvement.

A consulting neurosurgeon recommended an MRI of the spinal cord, and Dr. E. and Dr. V. agreed. A stat MRI could not be performed at this facility during overnight hours, so the patient was transferred to another hospital for the MRI and magnetic resonance angiography (MRA). Before the transfer, Dr. V. performed a thoracentesis in which 3,000 cc of fluid was drained.

The patient was gone from the hospital for a little longer than four hours. The MRI did not reveal any spinal cord compression, but the MRA showed complete occlusion of the abdominal aorta below the renal arteries. Dr. V. was informed of the results during a phone conversation with the radiologist.

When the patient was returned to the hospital, attempts were made to contact Dr. V., but Dr. V. never received those calls. Dr. V. returned to the ED after the patient had been there for about 40 minutes and told him that he needed immediate surgery. The patient, a veteran, requested that he be transferred to the VA hospital where his records were maintained. Heparin was administered and he was transferred to the VA hospital, accompanied by a nurse.

Upon the man’s arrival at the VA hospital, a surgical resident assessed his prognosis as poor, with or without surgical exploration. The patient’s wife called the ED a few hours later and requested that no intervention be performed until her arrival at the VA hospital.

When the family arrived there about three hours later, the vascular surgery chief resident advised them that the man’s prognosis was certain death with no intervention, and an 80% to 90% probability of death with thrombectomy/revascularization. The family agreed to surgery, which was begun more than 12 hours after the MRA was performed. The surgery, which included bilateral groin exploration, aortic thrombectomy, and bilateral fasciotomy, was completed after five hours with no complications.

The patient’s condition began to deteriorate two days later. CT revealed left parietal and right temporal hemispheric stroke. After further deterioration, the family requested DNR status, and the man died.

The plaintiff alleged negligence in the failure to timely diagnose and treat the aortic occlusion and in negligently allowing transfer to a VA hospital despite the decedent’s emergent and unstable condition. The defendants claimed that the decedent’s vital signs were stable throughout his care before transfer to the VA and that he was always alert and oriented.

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

Did Missed Orbital Fracture Lead to Nerve Impingement?
During a softball game, a 35-year-old New Jersey man was struck in the eye by a line drive. He went to a medical center ED where he was seen by an emergency physician. The physician did not order CT and, according to the patient, failed to diagnose a fractured orbit.

The man later developed an impinged infraorbital nerve as a result of untreated bone fragments, which allegedly resulted in permanent complications of the underlying injury. He claimed that CT was required, given the nature of the injury, because it would have revealed the fracture, allowing for timely treatment. The defendant maintained that CT was not necessary.

The jury found the physician negligent and also found that the physician’s negligence was the proximate cause of the plaintiff’s condition. The plaintiff received a $240,000 judgment.

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

Volvulus Missed in Gastric Bypass Patient
A 37-year-old woman presented to an emergency department (ED) in Kentucky with nausea and vomiting. The defendant emergency physician noted a soft abdomen. The woman’s vital signs were mostly normal; fluids were administered, and she was discharged with instructions that included an admonition to return if her symptoms worsened. 

The emergency physician had previously seen the patient several times in the ED for various complaints. In the previous three years, she had experienced weakness and other symptoms after successful gastric bypass, as a result of which her weight had dropped from 300 to 93 lb.

The woman returned to the ED that evening. It was claimed that the emergency physician was indifferent and dismissive, and that in one exchange, asked her, “What am I supposed to do for you?” The patient replied, “I’m not a doctor, I don’t know.”

The patient’s symptoms were unchanged, but her vital signs were stable. The emergency physician suggested blood work, which the woman refused. She was released that night with a prescription for pain medication and spent most of the following day in bed. She died during the night.

An autopsy revealed a volvulus of the jejunum, which had caused a fatal septic event. The plaintiff claimed that CT should have been performed, as it would have led to detection of the volvulus. The emergency physician claimed that CT was not required, based on the decedent’s presentation. The defendant hospital denied any negligence, arguing that the emergency physician was not an employee.

According to a published account, $2,192,000 was awarded against both defendants.

Too Little Testing, Too Little Follow-Up
In May 2004, a 49-year-old man went to defendant Dr. D.’s office in Pennsylvania for a physical examination. At this visit, the patient complained of muscle aches, joint pain, fatigue, impotence, and other symptoms. No laboratory tests were ordered.

In October 2005, the patient returned to Dr. D. with the same symptoms and a weight loss of 40 lb. Blood work was ordered at that time, which it was later claimed revealed hematologic abnormalities. Recorded findings included elevated levels of triglycerides (500 mg/dL) and total cholesterol (205 mg/dL), a low HDL cholesterol level (30 mg/dL), elevated blood glucose (308 mg/dL), and a low platelet count (63,000/L). The man’s alkaline phosphatase level was also elevated (172 U/L). No follow-up took place.

Later that month, the patient returned to Dr. D. complaining of persistent symptoms. At that time, Dr. D. suggested that results of an ECG the man had undergone were abnormal. However, Dr. D. still did not follow up on abnormalities in the patient’s blood work.

Early in January 2006, the patient contacted Dr. D. and reported that he was experiencing constant nausea, headaches, and decreased urination. Dr. D. instructed him to go to the ED. There, a chest x-ray revealed pulmonary vascular congestion, bilateral pulmonary effusions, and splenomegaly. Heart studies showed heart dysfunction, and blood test results indicated abnormal liver function.

Four days later, the man was transferred to another hospital for placement of an intra-aortic balloon pump. He died the following day as a result of undiagnosed and untreated hemochromatosis, which had led to multisystem organ failure.

The plaintiff claimed that Dr. D. failed to order blood work to rule out or confirm hemochromatosis or other medical conditions at the decedent’s first visit. The plaintiff claimed that Dr. D. was negligent in failing to follow up on the decedent’s complaints and later on his abnormal test results.

The defendant maintained that the decedent’s liver test results were normal and that his other health issues had given the defendant no reason to refer the man to a hematologist.

A defense verdict was reportedly returned.

Man With Aortic Occlusion Requests Transfer
A 59-year-old Illinois man awoke one morning experiencing back pain and the inability to move his legs. Paramedics responded and transported him to a hospital, where he was examined by Dr. E., an emergency physician. Dr. E. found normal vital signs, diminished lung sounds, no detectable pulses in the man’s legs, and mottled feet.

In consideration of the patient’s diabetic neuropathy, abdominal CT was performed without contrast dye; it did not reveal an abdominal aortic aneurysm, but it did show a large pleural effusion on both sides. Dr. E. believed there was a mass in the left lower lobe and suspected that aortic disease was present.

A vascular surgeon, Dr. V., was consulted regarding concerns of a possible occluded or dissecting aorta. Dr. V. found Doppler pulses in the groin and felt a faint femoral pulse on the left side. Dr. V. believed that there was an occluded aorta, but due to effusion in the chest, as well as the patient’s history of smoking, hemoptysis, weight loss, and acute-onset paralysis, Dr. V. also suspected a malignancy with spinal cord involvement.

A consulting neurosurgeon recommended an MRI of the spinal cord, and Dr. E. and Dr. V. agreed. A stat MRI could not be performed at this facility during overnight hours, so the patient was transferred to another hospital for the MRI and magnetic resonance angiography (MRA). Before the transfer, Dr. V. performed a thoracentesis in which 3,000 cc of fluid was drained.

The patient was gone from the hospital for a little longer than four hours. The MRI did not reveal any spinal cord compression, but the MRA showed complete occlusion of the abdominal aorta below the renal arteries. Dr. V. was informed of the results during a phone conversation with the radiologist.

When the patient was returned to the hospital, attempts were made to contact Dr. V., but Dr. V. never received those calls. Dr. V. returned to the ED after the patient had been there for about 40 minutes and told him that he needed immediate surgery. The patient, a veteran, requested that he be transferred to the VA hospital where his records were maintained. Heparin was administered and he was transferred to the VA hospital, accompanied by a nurse.

Upon the man’s arrival at the VA hospital, a surgical resident assessed his prognosis as poor, with or without surgical exploration. The patient’s wife called the ED a few hours later and requested that no intervention be performed until her arrival at the VA hospital.

When the family arrived there about three hours later, the vascular surgery chief resident advised them that the man’s prognosis was certain death with no intervention, and an 80% to 90% probability of death with thrombectomy/revascularization. The family agreed to surgery, which was begun more than 12 hours after the MRA was performed. The surgery, which included bilateral groin exploration, aortic thrombectomy, and bilateral fasciotomy, was completed after five hours with no complications.

The patient’s condition began to deteriorate two days later. CT revealed left parietal and right temporal hemispheric stroke. After further deterioration, the family requested DNR status, and the man died.

The plaintiff alleged negligence in the failure to timely diagnose and treat the aortic occlusion and in negligently allowing transfer to a VA hospital despite the decedent’s emergent and unstable condition. The defendants claimed that the decedent’s vital signs were stable throughout his care before transfer to the VA and that he was always alert and oriented.

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

Did Missed Orbital Fracture Lead to Nerve Impingement?
During a softball game, a 35-year-old New Jersey man was struck in the eye by a line drive. He went to a medical center ED where he was seen by an emergency physician. The physician did not order CT and, according to the patient, failed to diagnose a fractured orbit.

The man later developed an impinged infraorbital nerve as a result of untreated bone fragments, which allegedly resulted in permanent complications of the underlying injury. He claimed that CT was required, given the nature of the injury, because it would have revealed the fracture, allowing for timely treatment. The defendant maintained that CT was not necessary.

The jury found the physician negligent and also found that the physician’s negligence was the proximate cause of the plaintiff’s condition. The plaintiff received a $240,000 judgment.