Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Too Young for a TIA?
In May 2004, a 41-year-old Wisconsin man presented to the defendant neurologist, reporting episodes of vertigo, headaches, double vision, and occasional hallucinations. MRI was performed with results reported as normal, and the neurologist told the patient that the cause of his symptoms was most likely nonorganic.
The symptoms abated for a time, but when they began to recur in November 2005, the man returned to the neurologist. MRI was performed again and interpreted by the defendant radiologist, who noted that the patient had experienced a stroke in the brain stem. He sent a report to that effect on a “stat” basis.
A few days later, the patient presented to a hospital emergency department (ED) with worsening symptoms. When the neurologist was called, he claimed to be learning of the MRI results for the first time. The radiologist reportedly acknowledged that he had not documented where the “stat” report was sent; nor did he follow up to confirm that it had been received.
At the time of the man’s admission through the ED, he was found to have had a full-blown brain-stem stroke with blockage of the basilar artery. His symptoms progressed to a condition of locked-in syndrome. His condition gradually improved, but he was left with permanent weakness in the arms and legs, blurred vision, and difficulty swallowing. His leg weakness makes it impossible to stand or walk. He also requires injections of onabotulinum toxin A every few months to control left arm and leg spasms.
The plaintiff claimed that the neurologist should have made a diagnosis of transient ischemic attacks (TIAs), and that another MRI and other testing should have been ordered. The plaintiff maintained that additional testing would have led to recognition of narrowing in his basilar artery and appropriate treatment, thereby preventing the stroke. The plaintiff claimed negligence on the radiologist’s part for failing to confirm that the report of the acute brain-stem stroke had been received and acted upon.
The defendants claimed that even an earlier diagnosis and treatment would not have led to a better result. The neurologist also claimed that the plaintiff’s symptoms were not consistent with TIAs, particularly in a person of his age.
According to a published account, a $4.5 million settlement was reached.
Suspected Cellulitis–C difficile Colitis Link
In July 2005, a 71-year-old New York man presented to the defendant orthopedic surgeon, Dr. F., because his prosthetic right knee was painful and swollen. The surgeon, who had inserted the prosthetic hardware, found a stress fracture of the patella. Aspirated fluid was bloody; Dr. F., suspecting an infection, prescribed cephalexin.
Almost a month later, the patient returned and reported continuing problems with the knee. X-rays revealed loosening of the tibial component of the prosthesis. Again, aspirated fluid contained blood, and the defendant orthopedist continued to treat the patient for what he believed was an infection.
Two weeks later, Dr. F. performed exploratory surgery on the man’s knee. The prosthesis was removed, and an antibiotic spacer was implanted. A culture revealed a small amount of cellulitis. During this hospitalization, the patient received a diagnosis of Clostridium difficile colitis, which led to pulmonary and renal system failure, sepsis, fungemia, and a stroke.
The plaintiff was hospitalized until December 2005, then was transferred to a nursing home. He remained there until June 2006, when a new prosthesis was placed. He was hospitalized for that surgery until August 2006.
The plaintiff claimed that his cellulitis should have been diagnosed in July 2005 and that the surgery and colitis and its effects resulted from Dr. F.’s failure to make a timely diagnosis of cellulitis. The plaintiff argued that the fluid aspirated in July should have been cultured, that the cephalexin dosage should have been increased, and that a different antibiotic should have been prescribed.
The defendant claimed that the plaintiff’s knee was not infected when he examined it in July and that any infection present during the surgery was unrelated to the plaintiff’s colitis. The defendant maintained that cephalexin was an appropriate treatment choice, and that cellulitis would not have been detected by any test that could have been performed in July.
According to a published account, a $1.9 million verdict was returned.
When Was the Bowel Perforated?
A 34-year-old woman underwent surgery at a Michigan hospital for removal of her left ovary. The defendant surgeon attempted to perform the procedure laparoscopically but encountered extensive scar tissue resulting from several previous surgeries. He found the patient’s ovary adhered to the sigmoid colon and pelvic sidewall. After separating the ovary, the surgeon abandoned the plan to remove it completely out of concern for the adjacent ureter.