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.