Cases reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
A 39-year-old man was taken to the defendant hospital following a motor vehicle accident in New York State. He had jaw pain in addition to other complaints, and x-rays were taken. An emergency physician reviewed the results and determined that they were positive for a fracture of the radial head of the right wrist and negative for fractures of the mandible. The patient was treated for the wrist fracture and released.
The next day, hospital radiologists reviewed the man’s x-rays and noted a probable fracture of the right mandibular condyle. A radiologist contacted the emergency department (ED) to report the probable fracture. The emergency physician viewed the patient’s films again but believed that the radiologist was referring to the already diagnosed wrist fracture.
About three weeks later, the patient went to another physician complaining of persistent jaw pain and was sent for further x-rays. A diagnosis was made of a fractured mandible that had developed into a deformity of the mandibular joint. The man required two subsequent surgeries to reconstruct his jaw, but he now has temporomandibular joint dysfunction, a very painful condition.
The plaintiff alleged negligence in the emergency physician’s failure to diagnose the fracture. The hospital interpleaded a nurse practitioner who cared for the plaintiff in the ED and the treating emergency physician. The hospital claimed that the two clinicians were at fault for the delay in diagnosis.
Outcome
According to a published account, a defense verdict was returned.
Comment
Sometimes defendants win, and you can’t help but wonder why. The radiologist’s finding of a mandibular fracture would seem to override an emergency physician’s opinion to the contrary. The failure to correctly communicate or understand which fracture was in contention would not seem to be a very good explanation for this misdiagnosis. —JP