Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Atrial Fibrillation and Syncope After Leg Fracture
A 53-year-old man with a history of atrial fibrillation broke his leg in a fall. He was transported to the defendant hospital, where he received a cast. He was released with instructions to remain immobile.
Two days later, the man experienced an episode of syncope, atrial fibrillation, shortness of breath, seizure-like activity, and profuse sweating. He was taken by ambulance to the defendant hospital. By the time he arrived there, his atrial fibrillation had converted spontaneously to normal sinus rhythm, and his other symptoms had also resolved. The differential diagnosis included syncope, seizure, acute coronary syndrome, and pulmonary embolism.
An ECG performed at the hospital was negative for ischemia. Shortly after the test, however, the patient’s oxygen saturation fell to between 91% and 94% on room air, and supplemental oxygen was started. A chest x-ray was initially read as normal, but a radiologist who reviewed it noted that it was suggestive of pulmonary embolism. There was no indication that this was communicated to the emergency department (ED) staff.
CT was ordered but not performed until about three hours later. It revealed a large pulmonary embolism in the right and left pulmonary arteries. The scan was not read until an hour after it was performed—at about the same time that the man experienced fatal cardiac arrest as a result of the pulmonary embolism. The decedent had not been given anticoagulants at any time while in the hospital.
The plaintiff claimed that more aggressive testing should have been performed to rule out pulmonary embolism and that CT should have been performed earlier, with heparin administered until a diagnosis of pulmonary embolism was confirmed.
The defendants argued that the actions they took were proper and that the size of the pulmonary embolism made the decedent’s survival impossible.
According to a published account, a $1 million settlement was reached.
Defense Claims Placental Abruption Was Sudden, Unpredictable
A 38-year-old woman had received uneventful prenatal care from the defendant obstetricians since March. In October, she presented to the defendants’ office with persistent vaginal bleeding and abdominal and back pain. She was hospitalized for evaluation and electronic fetal heart monitoring.
After about one hour of monitoring, it was determined that the patient was not in labor. Reassuring signs of fetal well-being were also reported. The woman was discharged to home despite continued bleeding and abdominal pain.
She returned to the defendants’ office early that afternoon with complaints of increasing bleeding and pain. She was advised to go to the hospital for delivery. Shortly before arriving there, the patient experienced massive hemorrhaging in the car due to placental abruption. The infant was stillborn before an emergency cesarean delivery could be performed. The mother required transfusions for disseminated intravascular coagulation and blood loss.
The plaintiff claimed that she had been discharged from the hospital without a proper workup for persistent bleeding and abdominal pain and that ultrasonography should have been ordered.
The defendant claimed that the discharge was appropriate because the woman’s condition had improved and delivery did not appear imminent. The defendant also claimed that the sudden massive placental abruption was unpredictable.
A verdict of $1,651,166 was returned.
Surgery Delayed Due to Patient’s Body Habitus
In May 2003, a 48-year-old woman presented to the defendant hospital’s ED with complaints of left lower quadrant pain with possible gynecologic etiology. She was examined by the defendant general surgeon, Dr. B., who ordered CT. The test revealed a left pelvic inflammation and a possible cystic mass in the left ovary.
During the patient’s hospitalization, Dr. B. consulted with specialists in gastroenterology, pulmonary disease, family practice, infectious disease, and gynecology. The infectious disease specialist administered IV antibiotics as a precaution against an infectious process. The patient was discharged after 12 days’ hospitalization with a prescription for oral antibiotics from the infectious disease consultant.
The woman returned to the ED the following day, complaining of pain, shortness of breath, and diaphoresis. Her white blood cell count was 17,000/mL, which was consistent with findings from the previous week. Results of other laboratory tests were normal. Apart from revealing a resolving left lower lung infiltrate, abdominal x-ray yielded unremarkable results.
When the ED physician consulted with Dr. B., it was determined that the patient had been taking an insufficient amount of acetaminophen/hydrocodone for her body habitus (BMI, 53.2). The plaintiff was discharged with instructions to take the pain medication as prescribed and to follow up with her family clinician in two days.