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Specialties: |
Internal Medicine and Gastroenterology |
Category: |
Diagnosis |
Defendants: |
PCP, Gastroenterologist, Gastroenterologist's PPG |
Plaintiff: |
Wife, as administrator of the estate |
Result: |
Defense Verdict |
In October 1997, a 50-year-old male patient was referred by his primary care physician (PCP) to a gastroenterologist for colonoscopy and esophagogastroduodenoscopy (EGD) due to history of occult blood in his stool. Results showed hemorrhoids and several other conditions including gastritis, none of which was shown to be actively bleeding.
A repeat EGD in December 1998 showed no new findings. Due to the emergence of iron-deficiency anemia, a second colonoscopy was done in May 1999, with excision of three benign polyps and a finding of diverticulitis. At that time, small bowel radiological studies were normal.
In November 1999, the gastroenterologist concluded no further studies were warranted and referred the patient back to his PCP. In July 2000, the patient was found to have colorectal cancer. After surgery and chemotherapy, the patient died in October 2001.
The patient’s wife brought suit against the PCP and the gastroenterologist, alleging failure to diagnose the colon cancer in a timely manner. The case review showed only a six-week delay in the annual colonoscopy follow-up in May 2000, due to the patient’s travel schedule. All prior testing was negative. Expert review (internal medicine) supported the PCP, who appropriately referred the patient to gastroenterology for screening.
The expert gastroenterology reviewer believed the lesion was missed or that the tumor grew rapidly. The oncology review was supportive in that the cancer was likely present but could not be detected on colonoscopy, which has a 4-10 percent detection failure rate. A seven-day trial (November 2008) resulted in a defense verdict for all defendants.
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Specialty: |
Neurology |
Category: |
Diagnosis |
Defendants: |
Neurologist and Institution |
Plaintiff: |
Guardian, on behalf of the patient |
Result: |
Defense Verdict with pre-arranged payment |
In October 2000, a 45-year-old female patient with a two-month history of daily headaches was seen in the emergency department for severe headache with nausea. The patient was referred for a neurology consult, and was seen by the neurologist three days later. A CT scan and lumbar puncture ruled out cerebral hemorrhage. The patient was diagnosed with migraine headaches and prescribed amitriptyline.
On subsequent visits through July 2002, the patient reported to be doing well with headaches controlled with medication. Ten months following her last visit, in May 2003, the patient suffered a cerebral hemorrhage secondary to a ruptured aneurysm. Following multiple surgeries and a complicated post-surgical course, she has regained very little function, does not communicate, and requires full-time skilled nursing care.
The plaintiff alleged the neurologist was negligent in failing to order CTA or MRA to rule out cerebral aneurysm as possible cause of the patient’s headaches. CRICO’s expert reviews were supportive, indicating that the work-up, diagnosis, and treatment plan were appropriate. Pre-trial focus groups revealed some potential jurors were receptive to the plaintiff’s argument and that more testing should have been done, but most believed that it would not have changed the outcome.
In May 2009, a seven-day trial resulted in a defense verdict. This case featured a “high-low agreement” in which the defense and plaintiff arrange pre-set payment amounts linked to the trial verdict—removing the jury from any compensation decision. A finding for the defense (as in this case) results in the plaintiff receiving the low amount; a finding in favor of the plaintiff results in the high payment.
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Specialty: |
Surgery |
Category: |
Communication, including Supervision and Documentation |
Defendants: |
Two General Surgeons, two Chief Surgical Residents,
Surgical Resident, and Surgical Intern |
Plaintiff: |
Husband, as administrator of the estate |
Result: |
Settled in Mid-range |
In May 2003, a 35-year-old female was admitted to the Emergency Department (ED) for suspicion of small bowel obstruction, and taken to the OR for exploratory laparotomy. No obstruction was found, and the patient was discharged six days post-op. At discharge, the patient was instructed to schedule follow-up with the surgeon for staple removal. This did not occur.
Eight days after discharge, the patient presented again to the ED with abdominal pain, nausea, and vomiting. She was seen and evaluated by two ED residents and was admitted for conservative management by the surgical service. A CT scan performed within 12 hours of the patient’s admission was initially read by a radiology resident as showing “significant dilation throughout the small bowel, no transition point, and decompression of the descending colon.”
Narcotic withdrawal was considered on the differential diagnosis and the addiction service was consulted. Despite conservative measures (NG tube, fluids, and pain management) the patient’s condition deteriorated; she became unresponsive and was taken for emergency surgery while being resuscitated (36 hours after admission). Bowel perforation and extensive peritonitis were found at surgery; attempts at resuscitation were not successful and the patient died.
The final read of the CT by the attending radiologist (not available until two days after the patient’s death) included findings of dilated loops of small bowel, free fluid noted within the pelvis, decompressed descending colon, and a possible transition point seen in the midline abdomen.
The husband sued for wrongful death. Deposition testimony revealed a lack of communication between providers, lack of coordination of care by any attending physician, and multiple attempts by the nursing staff to alert physicians without an adequate response. “Diagnostic anchoring” on the patient’s history of narcotic addiction without a thorough investigation of her continuing pain may have distracted clinicians from appreciating the acuity of her illness. The case was settled in the mid-range.
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Specialty: |
Psychiatry |
Category: |
Medical Treatment (Patient Assessment and Monitoring) |
Defendants: |
Two Psychiatrists and the Hospital |
Plaintiff: |
Patient's Estate |
Result: |
Dismissed |
In October 2002, a 42-year-old male with a long history of bipolar, chronic depression, and substance abuse was admitted to the medical intensive care unit following an overdose. Three days later, after being medically stabilized, the patient was transferred to the facility’s locked psychiatric unit.
Due to continued depression despite multiple recent admissions and medication adjustments, Electronic Convulsive Therapy (ECT) was planned. The patient underwent 12 ECT treatments and continued with medication monitoring. Despite the treatment, the patient continued with depression.
Plans were made to transfer the patient to a long-term psychiatric facility. The patient, aware that long-term effects from his overdose would make discharge from that facility unlikely, opposed the discharge. The patient denied suicidal ideation but reported that, should he want to, he would run in front of a car during his smoke break. The patient had privileges to take outdoor smoke breaks, accompanied by mental health workers (MHA).
The psychiatric facility had outdoor break protocols related to location, duration, frequency, and staff/patient ratios that were approved by the Department of Mental Health. On December 20, 2002, the patient’s psychiatrist re-evaluated the patients risk for outdoor privileges and approved them (three per day); due to decreased depression that day, there was no reason to suspend privileges.
On December 22, 2002, the patient was on a smoke break with seven others and two MHAs (within protocol guidelines). After one cigarette, the patient took off from the group. One MHA attempted to chase after the patient but could not find him. The group was taken back to the floor and an escape protocol was implemented by an RN. When the MHAs went back outside to look for the patient, they discovered that he had jumped off the roof of the six-floor parking garage. He was pronounced dead on arrival at the emergency department.
The patient’s estate alleged that negligent care and inadequate supervision led to his wrongful death. Three days prior to trial—and after reviewing supplemental expert opinion which noted that the act of suicide is impulsive with no rational thought process, and more than 30,000 suicides occur on locked units in the United States each year—the plaintiff dropped the case. |
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