After a few days, she called Dr. D. and asked to come to the office for a complete blood count to check on her anemia. She also complained of minimal headaches and dizziness. She did not keep the appointment for her blood test. A little more than a week later, the plaintiff was taken to the hospital with a lump on her right abdomen. When CT revealed a mass, she was scheduled for surgery, which involved the removal of a 12-inch piece of bowel to treat a perforation of the bowel that was attributed to a Crohn’s flair.
The plaintiff claimed that the defendants had ignored her reported symptoms of a Crohn’s flair, which led to the perforation. The defendants claimed that the plaintiff had not had a Crohn’s flair during her pregnancy and that all of her complaints were attributable to the pregnancy.
Outcome
According to a published account, a defense verdict was returned.
Comment
Pain in a pregnant woman needs an explanation. The finding early in the patient’s pregnancy that there was no Crohn’s flare did not mean that a flare would not occur later. The defendants prevailed, but it appears that the obstetricians failed to determine a cause for the pain. If the obstetricians had kept the gastroenterologist in the loop, they might have been able to prevent the loss of bowel. —JP
Oral Neoplasm Goes Undiagnosed
An Ohio woman was under the care of Dr. V. from 1998 to 2006. She was being treated for fibrocystic breast disease, cysts, phyllodes tumor, and carcinoma. In 2006, the patient developed a malignant spindle-cell neoplasm in her mouth. The lesion metastasized to her lungs and brain, and she died in February 2007.
The plaintiff claimed that the defendant was negligent in her treatment of the decedent.
Outcome
According to a published account, a defense verdict was returned.
Comment
Failing to look into the oral cavity and then investigate any suspicious lesions—especially in a patient with a history of cancer—falls below the standard of care. Unfortunately, many clinicians have not had adequate education in oral health care and do not include an oral exam as a routine part of the physical examination. —RDD
Delayed Referral Renders Tendon Injury Irreparable
At age 39, a Nevada man sustained a complete rupture of his left distal biceps tendon after experiencing a hyperextension injury that occurred when a ping-pong table he was unloading suddenly slipped off the truck. The plaintiff was a personal trainer and a champion bodybuilder.
The injury was initially diagnosed at a non-party medical center; there, the patient was referred to a non-party orthopedist who recommended surgical repair to correct the deformity while preserving the man’s strength. The orthopedist believed that the time in which surgical correction could be accomplished was limited.
The patient decided instead to go to a Veterans Administration facility for care; he was seen by the defendant internist in the VA triage department one week after the injury. According to the patient, the defendant told him that there was no urgency to schedule the surgery and gave him a nonurgent referral to a VA orthopedist. The man also reported that the defendant ordered a nonurgent magnetic resonance angiogram (MRA) of the arm, filled out the proper VA forms for an orthopedic referral, prescribed ibuprofen and hydrocodone with acetaminophen, and instructed the patient to use a sling.
It was not until about six weeks after his injury that the patient saw a VA orthopedist, who then referred him back to the non-party orthopedist for surgery. The surgery was performed about nine weeks after the injury. By that time, the proximal tendon was found to be scarred and could not be reattached.
The plaintiff alleged that the cosmetic deformity and loss of strength in the arm could not be corrected. He claimed that an MRI, not an MRA, should have been ordered by the defendant, and that the defendant failed to obtain for him a timely referral to an orthopedic surgeon.
The defendant claimed that he had taken all of the proper steps to comply with the VA’s referral procedure. The defendant charged the plaintiff with contributory negligence for not seeing an orthopedist sooner and for his history of using anabolic steroids.
Outcome
According to a published report, a defense verdict was returned.
Comment
As in most malpractice cases, the “blame” is rarely black and white. While this is true in this case, it brings an important issue to bear. Timely referrals are extremely important, especially in orthopedic injuries, such as the one in this case. Referral policies should be reexamined to avoid lengthy referral times—particularly when a large organization is involved. —RDD