After exploratory surgery revealed a constriction of the stomach and tissue necroses, the patient underwent cholecystectomy, resection of the proximal two-thirds of the stomach, and esophagogastrostomy with insertion of a feeding jejunostomy tube. Despite additional surgery, the woman died a few days later as a result of acute respiratory distress syndrome.
The plaintiff claimed that the defendant surgeon should have followed up on the chest x-ray following the initial surgery. On the patient’s return to the hospital, it was additionally charged, he should have inserted a nasogastric tube and ordered CT or an upper GI series immediately.
The defendant claimed that paraesophageal hernia repairs tend to fail and that it was not alarming that the hernia had recurred. The defendant maintained that the decedent’s symptoms were consistent with gas bloat syndrome, a common side effect of Nissen fundoplication. The defendant also claimed that even if the recommended diagnostic workup had been initiated earlier, she would have died in any event.
A defense verdict was returned.
House MD Forgoes Cardiology Consult
A 60-year-old woman was brought to the defendant hospital’s emergency department (ED) complaining of chest pain, nausea, and diaphoresis. She reported a family history of heart disease and a personal history of hypertension and high cholesterol.
In the ED, the patient was treated with aspirin and nitroglycerin. ECG revealed an old inferior infarct and was consistent with acute anterior ischemia. A diagnosis of unstable angina was made. The patient was admitted to a cardiac telemetry unit, and the on-call cardiologist was asked to consult. The plan for care included serial ECG and enzyme studies.
Shortly after midnight, the house officer was contacted by a unit nurse and informed about a report of an elevated troponin level. The house officer saw the patient, but his examination failed to elicit complaints of chest pain or shortness of breath and he pronounced it unremarkable.
Six hours later, the woman was found in cardiac arrest. Her heartbeat was restored, but she had experienced brain damage. She was transferred to another hospital for cardiac catheterization and stenting. Cardiac catheterization revealed single-vessel disease, with 99% to 100% occlusion of the left anterior descending artery. The decedent did not regain consciousness and was placed on a ventilator. A week later, she was removed from the ventilator and died.
The plaintiff claimed that the house officer should have ordered a stat cardiology consultation, which would have led to appropriate treatment and prevented the decedent’s massive myocardial infarction and death.
According to a published account, a $600,000 settlement was reached.