Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Ethmoid Roof Penetrated During Sinus Surgery
The plaintiff, a 14-year-old boy, was evaluated by his pediatrician, then by a family physician, for pain in his left cheek and significant postnasal drip. He was given several courses of antibiotics, which did not relieve his symptoms. He was then referred to the defendant otolaryngologist, who recommended endoscopic sinus surgery.
The procedure, performed one month after the boy’s initial presentation, included four endoscopic bilateral procedures (total ethmoidectomy, maxillary sinus antrostomy, frontal sinusotomy, and reduction of inferior turbinates), in addition to partial resection of the left middle turbinate. The surgery left the patient with persistent bitemporal headaches, photophobia, and phonophobia.
The plaintiff claimed that during surgery, the right ethmoid roof was penetrated, causing a bone shard to become dislodged. A review of the materials sent to pathology after surgery, the plaintiff said, revealed the presence of brain matter. The plaintiff claimed negligence in the performance of the procedures and lack of informed consent.
According to a published report, a defense verdict was returned. Posttrial motions were pending.
”He Said, She Said” Over Obstetrics Patient
A 24-year-old woman expecting her second child went to the defendant hospital in labor. The defendant anesthesiologist, Dr. R., administered an epidural anesthetic block.
About 15 minutes later, the patient complained of difficulty breathing, and a nurse responded by raising the head of the bed, administering oxygen by mask, and calling Dr. R. to return to the room. The plaintiff soon complained of not being able to feel her legs and said she felt nauseous. She vomited and again complained of having trouble breathing.
The nurse made an emergency call for Dr. R. to return and began to administer oxygen using a manual ventilator. The anesthesiologist arrived, ordered the ventilation to be stopped, and pronounced the patient fine. The nurse, contesting this determination, placed a pulse oximetry clip on the patient; her oxygen saturation was measured at 62%.
The nurse urged intubation, but when Dr. R. attempted the intervention, he placed the tube into the esophagus rather than the trachea. The nurse then called a “code 99” emergency.
Responding members of the code team testified that Dr. R. had misplaced the intubation tube and that when the team leader attempted to reintubate the patient, Dr. R. shouted an expletive and shoved him away (which Dr. R. denied). Dr. R. then intubated the woman but did not secure the intubation tube. The code team leader also claimed that Dr. R. called for defibrillation, although the patient had a nonshockable rhythm.
An emergency cesarean delivery was performed, after which the code team defibrillated the patient. This maneuver apparently dislodged the intubation tube, necessitating a third intubation. The patient then began spontaneous respirations.
The plaintiff suffered anoxic brain injury. Despite three months of inpatient rehabilitation, she has the mental acuity of a five- to six-year-old and requires constant supervision.
Dr. R. denied that he was called the first time the nurse claimed to have called him. Dr. R. claimed that when he arrived, the plaintiff was turning blue; he argued that he, not the nurse, began to administer supplementary oxygen. He claimed that when he then attempted intubation, the plaintiff became agitated and broke the laryngoscope blade, necessitating reintubation. He also claimed that he, not the nurse, called the code.
The plaintiff claimed that the nurse had been negligent and that numerous late chart entries showed that she had ignored the plaintiff while she was decompensating. The hospital claimed that Dr. R. had placed a high epidural block, leading to the patient’s respiratory distress; this, along with Dr. R.’s failure to properly intubate the patient, resulted in her injuries.
According to a published report, a defense verdict was returned.
Anticoagulation Therapy Times Two
A 45-year-old woman who was taking warfarin underwent a cholecystectomy, with preoperative and postoperative medication adjustment based on her international normalized ratio (INR). IV heparin was administered after the surgery to raise her INR. At the time of the woman’s discharge, the primary surgeon prescribed her usual dose of warfarin. Unknown to the surgeon, a second-year resident also prescribed warfarin, as well as heparin injections.
The patient was instructed to follow up in the anticoagulation therapy clinic every three days. On the way home from her first visit there, she experienced a massive abdominal hemorrhage. Emergency laparotomy was required at a different hospital, where doctors were unable to identify the source of the bleeding.
Two weeks later, the patient was transferred to the original hospital. Shortly thereafter, she died of complications of a massive abdominal hemorrhage, including acute respiratory distress syndrome, sepsis, and multiorgan failure.