Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Was Surgery to Save Patient—or to Teach Residents?
A laparoscopic hysterectomy was performed on a 48-year-old woman. After the procedure, when the patient’s pain was disproportionate to what might be expected, it was discovered that the bowel had been perforated. She was transferred to another facility, where it was initially assumed that she would not survive.
During subsequent surgeries, almost all of the patient’s large and small intestines were removed. Although she has survived, she currently requires total parenteral nutrition 16 hours a day and is on a waiting list for transplantation of the intestines, stomach, and liver. The patient has been hospitalized 25 times since the initial event for dialysis, blood transfusions, and treatment of infections.
The plaintiff claimed that her survival was unexpected and that the physician at the receiving hospital performed surgery on the bowel as a teaching tool for his residents. The possibility of transplantation surgery was a factor in reaching a settlement, as there were concerns that a transplant could affect the plaintiff’s survival and her ability to participate at trial. Also in the settlement considerations was the plaintiff’s having gone on a public health insurance plan, which would have created a large lien in the event of a transplant.
A $2,975,000 settlement was reached.
Internal Bleeding Goes Undetected After Car Accident
A man who fell asleep while driving was involved in a rollover accident and was rushed to the emergency department (ED) of the defendant hospital. He was treated in the ED by Dr. R. for cuts and bruises. He had bruising on his stomach and was complaining of pain that he described as 10 on a pain scale of 10; he said he could not lie flat because of the pain. He expressed concern to Dr. R. that his accident might have dislodged a pain pump previously implanted in his stomach to relieve chronic back pain.
X-rays were taken, but neither CT nor MRI was ordered. The man was released to home.
His wife found him the next morning lying on the bathroom floor, barely alive. He was rushed back to the hospital but died shortly after his arrival there. Based on findings at autopsy, which included fractured ribs and a collapsed lung, the man’s death was attributed to internal bleeding.
Plaintiff for the decedent alleged negligence in a failure to perform the proper testing to diagnose the extent of the decedent’s injuries.
A confidential settlement was reached.
Recognized Complication of Epidural Anesthesia
A man complaining of abdominal pain was given a diagnosis of an inguinal hernia and was referred to the defendant surgeon for a surgical repair the following month. The surgeon decided to use an epidural anesthetic in order to test the strength of the repair at the conclusion of the surgery.
The patient reportedly became unresponsive during the surgery, but the procedure was continued. The patient awoke in the postoperative area with numbness and a burning sensation in both legs. He was also unable to urinate.
The man’s numbness and inability to urinate persisted after his discharge. He later presented to an ED, where he underwent catheterization for urinary retention. He was sent for a neurologic consult and was subsequently treated at a research center.
The plaintiff claimed that the defendant surgeon had chosen epidural anesthesia without obtaining his informed consent and against his wishes. He also claimed that the defendant anesthesiologist stated to the patient’s family that he might have inserted the epidural needle too far, thus introducing the anesthetic to an inappropriate area. Additionally, the plaintiff claimed he had been told that something had struck his spinal cord during the epidural. The plaintiff charged the defendant anesthesiologist with negligence in piercing the dura and injuring the spinal cord. The litigation ultimately went forward against the anesthesiologist alone.
The plaintiff claimed that the injection of an excessive dose of anesthetic beyond the dura caused weakness in the legs, as well as neurogenic bowel and bladder.
The defendant claimed that the anesthetic intended for the epidural space spread to the subarachnoid space, causing a neurotoxic reaction that damaged the spinal cord. The defendant maintained that this was a recognized complication and not the result of any negligence. The defendant also claimed that the plaintiff had been told of the potential risks of the epidural.
According to a published account, a defense verdict was returned.
Severe Abdominal Pain After Tubal Ligation
A woman, 28, underwent tubal ligation and was released the same day. She returned to the hospital’s ED that night complaining of severe abdominal pain. She was seen by an ED physician, Dr. M., who ordered oxycodone with acetaminophen but did not specify the dosage; the woman was given between 5 and 10 mg. When her pain persisted, Dr. M. ordered hydromorphone and promethazine, to be administered by injection.