Injury to Spinal Accessory Nerve During Excisional Biopsy
The patient, age 41, consulted with the defendant general surgeon regarding a mole on his wrist that had recently changed color. He was also concerned that an enlarging mass on his neck might be some type of cancer. The surgeon recommended and performed an excisional biopsy of the mass on his neck. It was in the posterior cervical triangle just beneath the skin, with size, shape, and color resembling those of an enlarged lymph node. According to pathology reports, the mass on the man’s neck was determined to be a benign schwannoma, and the mole on his wrist to be a benign nevus.
When the plaintiff returned about one week later, the surgeon expressed concern about a possible injury to the spinal accessory nerve. Examination findings, however, indicated that the spinal accessory nerve was intact.
Five months later, the patient’s primary care provider noted some weakness in the trapezius muscle and winging of the scapula. He was referred to a neurologist, then an orthopedic surgeon, who made a diagnosis of an injury to the spinal accessory nerve.
The plaintiff claimed that a fine-needle aspiration biopsy or an incisional biopsy should have been performed before the excisional biopsy, that the defendant surgeon failed to recognize the schwannoma during the surgery, and that the defendant performed an inadequate examination and missed the injury to the spinal accessory nerve at the postoperative visit.
The defendant argued that an excisional biopsy was the best way to determine whether the mass on the plaintiff’s neck was cancerous and that one would expect the spinal accessory nerve and its input branches to be much deeper than just beneath the skin. The defendant also speculated that the schwannoma was on one of the input branches rather than on the spinal accessory nerve itself, explaining the normal examination findings at the postoperative visit.
According to a published account, a defense verdict was returned.
Off-Label Use of Antiemetic in Girl, 9
A 9-year-old girl was taken to the emergency department (ED) on a Friday after several episodes of vomiting and diarrhea. She was examined by the defendant ED physician, who ordered laboratory studies and administration of 1.0 L normal saline with dextrose and 10 mg of metoclopramide. The child’s condition improved, but she experienced one more episode of vomiting and diarrhea before going home. Neither the nurses nor the ED physician were made aware that this had occurred.
The patient was discharged with oral metoclopramide for nausea and vomiting, and written instructions were given that warned the family about abdominal pain symptoms and possible appendicitis. A few hours later, the child experienced vomiting and diarrhea after eating soup.
The parents called the hospital and were advised to follow up with the girl’s pediatrician, as recommended. The vomiting and diarrhea persisted on Saturday. Two more calls were made to the hospital with similar advice given. Early on Sunday morning, the child experienced shortness of breath, which improved after she drank water.
About three hours later, she collapsed in cardiopulmonary arrest and was taken to a different hospital and resuscitated. She was then transferred to a children’s hospital, where she died.
Plaintiff for the decedent claimed that metoclopramide is not recommended for pediatric use, that at least 2 L of IV fluids should have been administered, and that the decedent should have been observed for several hours before discharge. The plaintiff also claimed that after two or three calls to the hospital, the ED staff should have instructed the family to bring her back to the ED.
According to a published report, the hospital settled with the parents for a confidential amount. The remaining defendants denied liability, arguing that the decedent’s weight (159 lb) required an adult dose of metoclopramide, which they maintained is commonly used off—label as an antiemetic in children. The defendants also claimed that the family was specifically told to return to the ED with the decedent if she developed abdominal pain.
A defense verdict was returned.
Polio Contracted From Vaccinated Infant’s Diaper
In May 1979, a 31-year-old man contracted polio. It was determined that the virus was transmitted by a stool with which he came into contact while changing his infant daughter’s diaper. The stool contained a live strain of poliovirus, originating from a routine oral poliovirus vaccination that the infant had recently been given by the defendant pediatrician.
The plaintiff sued the pediatrician and the manufacturer of the vaccine. The plaintiff claimed that the vaccine should not have been administered without a warning regarding its associated hazards. The plaintiff claimed that he had contracted the type III strain of polio; this strain, it was claimed, originated from genetically unstable lots that exceeded the federal government’s reference standard for public distribution. The plaintiff claimed that the vaccine manufacturer was aware that these strains could enter the alimentary tract, revert to their wild form, and be excreted in the stool.