Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Recommendation Unheeded for Endocrinology Referral
A middle-aged man was referred by his primary care physician to the defendant pulmonologist in October 2002 for a sleep apnea consult. The patient complained of snoring, gasping for air at night, and daytime drowsiness. The pulmonologist, noticing that the man had coarse facial features, asked him whether anyone had ever mentioned facial changes to him; the man replied, “No.” The pulmonologist ordered blood work, including a random growth hormone sampling to test for excessive growth hormone.
The pulmonologist advised the patient to see his primary care physician for a possible referral to an endocrinologist. The man was also sent for an overnight sleep study to be tested for sleep apnea. The pulmonologist communicated with the patient’s primary care physician, mentioning the possibility of acromegaly and recommending an endocrinology consult. The primary care physician did not provide the referral to an endocrinologist, however.
The plaintiff returned to the defendant two months later for results of his sleep study. During that visit, the defendant informed him that findings from the growth hormone test were inconclusive. He advised the patient to return to his primary care physician for an endocrinology referral. The plaintiff was also instructed to return to the defendant pulmonologist in one month. The plaintiff never returned to the defendant and did not return to his primary care physician for 17 months.
The man was ultimately diagnosed with acromegaly, the production of excess growth hormone by the pituitary gland. He lost 90% of his pituitary gland and complains of double vision, cranial nerve injuries, hypopituitarism, diabetes insipidus, and sexual dysfunction.
The plaintiff claimed that the defendant pulmonologist wrote an “ambiguous” letter to the primary care physician (also a defendant in the case) that failed to specifically direct that physician to order an endocrinology consult. The plaintiff also claimed that results of the growth hormone test should have been forwarded to the primary care physician. The plaintiff claimed that diagnosis of acromegaly and appropriate treatment in 2002 or 2003 would have led to a cure for the pituitary tumor.
The defendant argued that his correspondence was clear regarding the need for an endocrinology consult and that forwarding the laboratory report was not required because results were inconclusive. The defendant also claimed that even with earlier treatment, the plaintiff’s condition would have been unchanged.
According to a published account, a defense verdict was returned. The primary care physician settled for an undisclosed amount prior to trial.
Post–Cesarean Surgery Complaints Overlooked
A woman underwent a cesarean delivery, performed by the defendant obstetrician with the assistance of two surgical nurses. At the conclusion of the procedure, the nurses informed the obstetrician that the sponge count was correct, and the surgical wound was closed.
About five months later, the patient complained of pain and tenderness in her abdomen; two months later, she went to the emergency department (ED) and was instructed to consult with her primary care physician. At that time, the patient did not have any pain but said her abdomen was “hard.”
One week later, the patient was seen by a different obstetrician/gynecologist, who ordered an abdominal CT. The test revealed that a surgical sponge had been retained during the cesarean delivery. The woman underwent surgery at the original hospital for removal of the sponge. The hospital eventually wrote off the charges for this surgery.
The plaintiff charged the nurses with negligence in miscounting the sponges and the defendant obstetrician for failing to refer her to another provider to determine the cause of her pain. A $159,000 settlement was reached with the hospital and the nurses.
The matter proceeded against the obstetrician, with the plaintiff claiming that the obstetrician should not have relied solely on the nurses’ sponge count and that she should have been more diligent about responding to the plaintiff’s complaints after the surgery.
The defendant claimed that she had acted appropriately in relying on the nurses’ sponge count and maintained that the plaintiff had no signs of fever or infection when she saw her two months after the surgery. The defendant also claimed that she repeatedly referred the plaintiff to other health care providers, including a neurologist and her primary care physician. She argued that the plaintiff had gone to the ED at least twice and had undergone ultrasonographic tests that did not detect the presence of the sponge. Finally, the defendant maintained that the plaintiff had no residual complications following the removal of the sponge.