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.