Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Delayed Treatment for Postsurgical Breathing Problem
At age 54, a man underwent cervical diskectomy and fusion at the defendant hospital. Six hours after being taken to the postsurgical floor, the plaintiff began to experience swallowing and breathing difficulties.
An hour and 10 minutes later, a nurse contacted the in-house intensivist to intubate the patient. During the attempted intubation, the man's throat was lacerated, and the bleeding made intubation impossible. During this time, his blood oxygenation saturation dropped to 35%. The emergency department (ED) physician was called to the bedside, and a temporary airway was established. An emergency tracheostomy was then performed.
The man was eventually discharged, but his original cervical spine surgery site became infected. He required a second surgery for debridement and removal of a titanium plate that had been placed during the original procedure. After five weeks' administration of antibiotics through a peripherally inserted central catheter line, the patient's infection was cleared.
The plaintiff alleged emotional distress while he was choking and claimed to have sustained hypoxic brain damage, which resulted in short-term memory problems; he was unable to return to work for nearly one year after the original surgery. The plaintiff claimed that the floor nurse was negligent for not having alerted a doctor as soon as he began to have respiratory difficulties. The plaintiff claimed that the nurse made false chart entries after the event, reporting that he had tried to call the surgeon; the plaintiff maintained that no call was made. The plaintiff also claimed that the surgical site infection resulted from the throat laceration, which allowed bacteria to be delivered to the area.
The defendant denied any negligence by the floor nurse and contended that his chart entries were accurate and timely. The defendant argued that bleeding and hematoma were risks associated with cervical spine surgery. The defendant also claimed that the laceration was a risk of intubation, especially in light of the plaintiff's jaw clenching in reaction to the administration of the short-acting IV anesthetic etomidate.
According to a published account, a defense verdict was returned.
Barium Swallow Might Have Made a Difference
Shortly after undergoing bariatric surgery, a 43-year-old woman began to exhibit signs and symptoms of an intra-abdominal infection. By then, the patient's surgeon had departed for a long holiday weekend, leaving a covering surgeon in charge of her care. The covering surgeon ordered a "blue-dye test," but no leak was detected; a barium swallow, which is considered more accurate, was not performed.
The patient's condition deteriorated. During a chance call to the hospital, the surgeon who had performed her operation learned that the woman was doing poorly. He returned quickly and immediately performed a second surgery. By then, the abdomen could not be closed, due to the extensive infection and development of compartment syndrome. The patient developed multiorgan system failure and died the day after her second surgery.
The plaintiff claimed that the covering surgeon ordered a test that was not definitive, that he should have ordered the barium swallow, and that he should have been prompted by the infection to initiate the second surgery.
The defendants claimed that infection is a well-known and potentially fatal risk of bariatric surgery, and the decedent had been so informed. The plaintiff countered that considering the known risk for infection, a barium swallow should have been conducted before the patient was too ill to recover.
According to a published account, a $750,000 settlement was reached.
Tear in Superior Vena Cava—Before or After Suicide Attempt?
A 54-year-old woman with suicidal ideation presented to a hospital emergency department (ED) complaining of chest pain, after a failed suicide attempt with a combination of heroin, cocaine, and methadone. She was admitted under the care of the defendant internist, and a cardiologist (also a defendant) was consulted. The patient's admission hemoglobin level was within normal range but dropped significantly within two days. When she experienced acute renal failure and shock, she was moved to the ICU, where she received copious amounts of fluid to raise her blood pressure. After being discharged from the ICU, she underwent a cardiac catheterization, which revealed no structural damage to the heart.
The next day, the woman went into cardiac arrest and died despite resuscitation efforts, including placement of a central line by way of the internal jugular vein. Autopsy revealed a 1,700-g blood clot in the right chest and a large tear in the superior vena cava as the source of the bleed. The medical examiner associated the perforation with instrumentation, such as a central catheter.