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.