Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Delayed Treatment for Preeclampsia
A woman experiencing her first pregnancy had an expected due date of December 5. She had been attending her prenatal appointments regularly with the defendant obstetrician/gynecologist. In October, she presented to the defendant hospital with complaints of left upper quadrant abdominal pain. Her blood pressure was elevated. She was discharged the next day.
Two days later, the patient made a scheduled visit to the office where she was receiving her prenatal care. Because she was noted to have protein in her urine, she was sent to the hospital for hypertension testing and a 24-hour urine test. It was determined that she had either pregnancy-induced hypertension or mild preeclampsia. She was sent home with instructions for biweekly fetal nonstress testing and a repeat 24-hour urine test.
A few days later, the patient presented to the hospital for a biophysical profile test. Her blood pressure was elevated. Physical examination revealed 2+ edema, and she was admitted to the hospital for monitoring.
Two days later, a resident documented a plan to repeat lab work for pregnancy-induced hypertension and continue the current care plan. The attending physician, however, discharged the woman with a diagnosis of preeclampsia. She was told to follow up on an outpatient basis.
Two days later, the patient returned to the hospital with a headache and elevated blood pressure. A biophysical profile test was nonreassuring, with fetal heart rate decelerations noted. A cesarean delivery was performed. Blood gas measurements after the child’s birth indicated metabolic acidosis. The infant was transferred with records indicating neonatal depression. Head CT revealed intraventricular hemorrhage.
The defendants claimed that this was a prematurity-related injury that could not have been prevented. The defendants also argued that the child had a normal IQ and mild cerebral palsy and was functioning well with few residual effects.
According to a published account, a $1.9 million settlement was reached.
Difficult Bead Removal Blamed for Ear Damage
When a woman discovered that her 5-year-old son had a bead stuck in his ear, she took him to a hospital emergency department, where he was seen by the defendant emergency physician. He made two attempts to remove the bead without sedating the child; the mother tried to hold him still, but he wriggled and screamed. Nurses also tried unsuccessfully to hold the child still, until blood was noted coming from his ear.
The emergency physician and the defendant family practitioner then sedated the child, and the latter spent more than an hour attempting to remove the bead. Eventually, he succeeded. As a result of the incident, however, the child suffered hearing loss that, despite reconstructive surgeries to repair the damage, will require hearing aids.
The emergency physician settled before trial for $40,000. The plaintiff claimed that the defendant family physician tried for too long to remove the bead and that his visualization was obscured by blood in the ear, resulting in rupture of the tympanic membrane and severe damage to the ossicular structure of the middle ear.
The defendant argued that he used suction to clear the field and did not use any instruments without having good visualization of the bead. He maintained that the main problem in removing the bead was a stricture in the ear canal where the temporal bone meets the cartilage.
The defendant also argued that the mother failed to return the child to his office in 10 days, as he had requested, in order for him to assess the extent of damage to the ear—an assessment he was unable to make immediately after removing the bead due to blood in the child’s ear.
According to a published report, a defense verdict was returned.
Alcohol and Hydromorphone a Bad Mix
After drinking alcohol all day, an obese 37-year-old man began to experience severe abdominal pain. Paramedics were called to his home, and he was transported to the defendant hospital emergency department (ED). Breath analysis indicated a blood alcohol level of 0.207, indicating very serious intoxication. The patient was noted to be alert, oriented, and cooperative, but he was anxious about his pain, which he rated as 10 on a 1-to-10 scale.
The defendant physician ordered IV fluids, including IV hydromorphone, 1 to 2 mg every 20 minutes as needed, with a note to keep the systolic blood pressure at 100 mm Hg or higher. The defendant made that order without evaluating the patient.
Over the course of one hour, the patient was administered 6 mg of hydromorphone. According to the patient’s record, only one full set of vital signs was taken during that time. Continuous monitoring was not performed, as the patient had been placed in an overflow room.