Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Was Follow-Up Adequate After Neurosurgery in Cancún?
Shortly after arriving in Mexico for a brief stay, a 44-year-old woman collapsed in the customs area. She was taken to a hospital in Cancún, where she underwent emergency neurosurgery for a brain bleed. After several days of hospitalization, she was stabilized and returned to Michigan with instructions to see her family clinician.
Her appointment was delayed by an ice storm, which interrupted power to the office of the defendant internist, Dr. M. That Saturday, the woman visited the office's clinic and was examined by the defendant family practitioner, Dr. P. She presented with a shaved head and a neurosurgical scar on the left side of her head; she complained of headache and some blurred or double vision. She gave Dr. P. a list of medications and medical records (in Spanish) from the Mexican hospital.
Findings on her physical examination were normal. She was instructed to return to see Dr. M., and she did so at the clinic on the following Monday. She repeated her complaints of double vision, headache, and fatigue. Dr. M. charged his office staff with attempting to have the Mexican records translated and to arrange for a neurosurgery appointment.
The patient was ultimately scheduled for head CT and an office visit with a neurosurgeon six days later. The day after those arrangements were made, however, she experienced a massive brain bleed and died.
According to the plaintiff, the surgeons in Mexico drained the blood from the initial bleed but did not detect its source—an aneurysm in the subarachnoid space. The plaintiff alleged that the defendants should have hospitalized the decedent immediately upon her return from Mexico or sent her for an immediate neurosurgical consult. Had the decedent undergone CT immediately, it was argued, the aneurysm would have been detected, surgery would have been performed, and she would have survived.
The defendants argued that the neurosurgical follow-up was out of their area of expertise and that they made appropriate arrangements for the decedent to be seen by a neurosurgeon. They maintained that the decedent appeared stable and seemed to be improving and that it was possible that the fatal bleed was not related to the first bleed. The defendants also claimed that definitive treatment should have been given in Mexico.
According to a published report, a defense verdict was returned.
Ultrasound Misplaced, Diagnosis Delayed for a Year
In March 2003 at age 2, the minor plaintiff was admitted to the defendant hospital under the care of the defendant pediatric urologist, who was treating her for bilateral vesicoureteral urinary reflux and frequent urinary tract infections (UTIs). The defendant surgically reimplanted both ureters to stop urinary reflux. The toddler was discharged to home in her parents' care two days after the procedure.
The child continued to experience UTIs. Renal ultrasonography revealed a blockage in the left ureter, but the ultrasound was lost by the defendant hospital. Results were never conveyed to the ordering physicians, who failed to follow up to obtain them.
In April 2004, the defendant urologist diagnosed the condition and determined that it had gone untreated for a year. Repeat renal ultrasonography demonstrated the blockage, and a nuclear renal scan confirmed that the child's left kidney was no longer functioning at all as a result of urinary backup. In addition to losing all function of the left kidney, the child has compromised function in the right kidney. She is expected to require dialysis in the future and eventually kidney transplantation.
A $9.75 million settlement was reached.
Complications of Undiagnosed Diverticulitis
A 62-year-old woman visited the defendant internist with complaints of abdominal pressure, poor appetite, weakness, and dizziness. Her medical history included hypertension, diverticulitis, hysterectomy, and tonsillectomy.
The defendant ordered a chest x-ray, complete blood count, and urinalysis. After reviewing test results, the defendant made a diagnosis of urinary tract infection and prescribed ceftriaxone by intramuscular injection and oral ciprofloxacin.
After receiving the first injection of ceftriaxone, the patient called the defendant's office, complaining of increased discomfort. She requested admission to the hospital, which was allegedly refused by a member of the office staff. The following day, the plaintiff was transported to the hospital by ambulance with complaints of left lower quadrant pain, intermittent for one week and worsening that evening. The plaintiff reported no nausea or diarrhea but was belching.
The emergency department physician identified tender palpation in the abdomen with no rebounding and decreased bowel sounds. The defendant internist's answering service was contacted, and the covering physician ordered admission with a diagnosis of diverticulitis. CT of the abdomen and pelvis revealed evidence of free air under the hemidiaphragm, ascites, and phlegmonous reaction; the results also suggested diverticulitis with perforation in the rectosigmoid region and inflammatory changes.