Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Empiric Dilation Leads to Esophageal Perforation
A 61-year-old man presented to the defendant gastroenterologist, Dr. B., complaining of intermittent difficulty swallowing liquids. Dr. B. made a diagnosis of liquid dysphagia and performed an upper endoscopy that day. About 10 minutes into the procedure, observing no stricture in the esophagus, Dr. B. decided to perform an empiric dilation.
Immediately after the procedure during the patient’s recuperation in the postanesthesia care unit, he began to complain of pain whenever he inhaled deeply. A chest x-ray showed nothing, and the patient was given an analgesic for pain relief. An hour later, when the man continued to complain of pain, he was given more pain medication but experienced no improvement.
After four hours, a Gastrografin® scan was performed. It revealed leakage into the mediastinum, confirming a perforated esophagus. A surgical consult was then ordered, and about seven hours after the initial procedure, a vascular surgeon performed surgery to repair the perforation. The man died of complications of acute respiratory distress syndrome, sepsis, and pneumonia about one month later.
The plaintiff alleged negligence in Dr. B.’s failure to obtain the decedent’s medical history before performing the upper endoscopy, in failing to inform the decedent of the dilation, and in failing to obtain informed consent for the dilation. The plaintiff contended that an empiric dilation would have been appropriate only if a stricture had been seen in the esophagus.
The defendant argued that an empiric dilation is proper whenever a patient has symptoms of dysphagia and that perforation is a known risk of the procedure—information that he claimed was communicated to the decedent.
The plaintiff argued that the consent form the decedent signed did not include any reference to a dilation procedure, nor did it detail the risks of the empiric dilation.
According to a published account, a defense verdict was returned.
No Testing for Infant With Large Head Circumference
The plaintiffs’ child was born in February 2005 at the Air Force base where his father was stationed. From the time of the child’s birth until his father’s honorable discharge in May 2005, the infant received clinical care from the medical staff at the base.
Shortly after the father’s discharge, the infant was seen by a pediatrician, who immediately referred him for head CT. He was diagnosed with hydrocephalus and underwent immediate neurosurgery for shunt placement. Since then, the child has undergone shunt revisions, eye surgery, speech therapy, occupational therapy, and physical therapy.
The plaintiffs charged the medical staff at the Air Force base with failure to diagnose the child’s hydrocephalus. The plaintiffs claimed that the child’s head circumference was near the top of the growth chart, that the infant had strabismus (crossed eyes), and that he had failed to reach developmental milestones. The plaintiffs argued that together these factors should have prompted the medical staff at the Air Force base to order diagnostic testing.
The defendants claimed there was no negligence in the failure to diagnose hydrocephalus because the child’s head circumference was not “off the chart.” They also claimed that the family did not complain of strabismus and failed to obtain timely care for the infant after the military discharge. The defendants maintained that the child would have had his current cognitive deficits even if a diagnosis had been made earlier. This claim was based on the defendants’ contention that the child had the congenital condition known as Dandy-Walker syndrome.
According to a published account, a $1.5 million settlement was reached. This included $1 million to be placed in trust for the child’s future care and treatment.
Was Hyponatremia Corrected Too Rapidly?
A 60-year-old woman went to a community hospital emergency department (ED) with a two-week history of cough, diminished appetite, decreased oral intake, and generalized body aches. She had been advised to go to the ED by staff at an urgent care center, where laboratory studies revealed critically low sodium and potassium levels. In the ED, she described herself as very weak and tired with body aches and pain.
According to lab tests performed at the ED, the woman’s sodium and potassium levels had fallen further. She was admitted to the ICU, where she was seen by the defendant physician. He ordered IV fluids with normal saline and potassium supplements, then ordered that the patient be transferred to the ICU at the defendant teaching hospital. There, the patient continued to be administered IV sodium and potassium until she was discharged home. Her final diagnoses included hyponatremia and hypokalemia.