Cases reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Delays, Missteps in Care of Child
The parents of a developmentally disabled 4-year-old boy took him to a Pennsylvania emergency department (ED) because he was vomiting and running a fever. The child had a heart rate of 180 beats/min and a respiratory rate of 40 breaths/min, but the triage nurse returned the child to the waiting room. Two hours later, another nurse recorded the child’s temperature, which revealed a fever. About 20 minutes later, a doctor saw the child and ordered acetaminophen and IV fluids, “stat.” A nurse requested an IV team, but it was not until an hour later that the fluids were finally administered. A few minutes after the line was placed, the child experienced a seizure and cardiac arrest. He died within the next hour.
The child’s adoptive mothers claimed that the hospital staff did not properly monitor the child’s vital signs, particularly in light of the child’s fever. The plaintiffs also claimed that the staff was negligent in waiting an hour to begin IV fluids when the order was “stat.” The plaintiffs also maintained that acetaminophen was never administered, despite the “stat” order.
Outcome
A $1 million settlement was reached.
Comment
“Stat” means “stat,” and not an hour later. But the failures here are more than just delay. A child with these vital signs was improperly triaged back to the waiting room when he needed constant vital sign monitoring at the least. Under these circumstances, checking vital signs two hours later was negligent. The jury came to a proper decision. —JP
Sponge Found Four Years After Laparotomy
A pregnant woman in her 30s went to a Michigan ED because she was bleeding and had abdominal pain. An ob/gyn performed emergency surgery to rule out an ectopic pregnancy. During the procedure, he found an ectopic pregnancy and performed a left salpingectomy. The patient was discharged the next day but continued to have abdominal pain.
Four years later, at another hospital, the woman underwent CT because of an injury. The imaging revealed an object in her abdomen. She underwent an exploratory laparotomy; the object was removed and identified as a surgical sponge. After this surgery, the plaintiff developed an umbilical hernia and an infection.
The plaintiff claimed that the surgical sponge was left during the surgery that was performed four years earlier. She denied having undergone any other procedures between the salpingectomy and the surgery in which the sponge was removed.
The defendants claimed that the sponge that was removed was not the type that would have been used in the original procedure. The defendants also argued that the sponge counts were correct and that a retained sponge was a risk associated with the procedure.
Outcome
A defense verdict was returned.
Comment
How the defendants prevailed in this case is a mystery to me. In the absence of another explanation, a sponge found in the abdomen after a surgery is malpractice. Res ipsa loquitur, a Latin phrase meaning “the thing speaks for itself,” is the appropriate legal term to describe this situation. In cases like these, the plaintiffs don’t even need an expert to prove malpractice. Sponge counts always seem to be right, even when they are wrong; otherwise, the surgeon would not have closed the abdomen. I wish someone could tell me where that sponge came from. —JP
Heart Murmur Overlooked in College Athlete
A 19-year-old man who received a college basketball scholarship needed a physical examination for medical clearance to play. The physician who conducted the exam noted a “slight systolic heart murmur” and documented it on the college’s physical exam form. This finding may be consistent with hypertrophic cardiomyopathy, a congenital heart defect associated with a transient systolic murmur and known to cause sudden death in athletes. The physician ordered an echocardiogram and signed the college medical clearance form, stating that the young man was in excellent health and did not require any physical restrictions.
Three and a half years later, while playing in a college basketball game, the young man suddenly collapsed to the floor and became unresponsive. Emergency medical personnel arrived and attempted to revive him. The young man was taken to a hospital, where further attempts to revive him proved unsuccessful. He died at age 22, four months shy of being awarded his college degree.
The plaintiffs claimed that the examining physician was negligent in signing the medical clearance form before establishing whether the student’s heart murmur indicated a life-threatening cardiac condition and for failing to note that an echocardiogram was pending. The plaintiffs also claimed that the defendant had failed to follow up on the results of the echocardiogram and that an ECG should have been performed to evaluate the murmur. The plaintiffs claimed that the student would have had a normal life span if he had been diagnosed and treated properly.