Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Cesarean Delivery Too Late to Prevent Uterine Rupture
A pregnant woman with hypertension and associated medical concerns was admitted to the hospital for induction of labor. She had previously undergone a cesarean delivery.
Synthetic oxytocin was started. That evening, dinoprostone was administered, and synthetic oxytocin was substituted for it the following morning.
That afternoon, the patient complained of severe uterine pain. She was 3.0 cm dilated and 60% effaced; she was then given butorphanol tartrate.
Because labor was not progressing, the defendant obstetrician decided to perform a cesarean delivery, then left with the nurse to attend to another patient. When the nurse returned, she noted that the fetal heart rate tracing had become dangerously slow, and she paged the obstetrician.
By the time he arrived, the membranes had ruptured. A fetal scalp electrode was placed, revealing a fetal heart rate of 70 beats/min. A "stat" cesarean delivery was ordered.
Twenty-four minutes elapsed from the time the fetal heart rate anomaly was noted to the time the incision was made. The uterus was found to have ruptured; the infant, a boy, was floating in the woman's abdominal cavity under her diaphragm. He was resuscitated and transferred to a children's hospital, where he was diagnosed with hypoxic ischemic encephalopathy and choreoathetoid cerebral palsy.
The plaintiff charged the defendants with negligence in failing to perform the surgery earlier. The defendants denied any negligence and contended that the woman's complaints of pain were not extraordinary.
According to a published account, a defense verdict was returned.
Conflicting Accounts About ED Referral for Man With Back Pain
After being given prescriptions for carisoprodol and hydrocodone with acetaminophen for back pain, a 26-year-old man returned to Dr. S., the defendant primary care physician, complaining of unremitting pain. Dr. S., who had been treating the plaintiff for staph infections, suspected a spinal epidural abscess. He prescribed naproxen, referred the patient to a laboratory for blood testing, and directed him to go to the emergency department (ED) if the pain worsened or if he developed neurologic symptoms.
That evening, the man's pain worsened, and he was taken to the ED. The ED physician considered a differential diagnosis that included epidural abscess. After consulting with the on-call primary care physician, the ED physician wrote holding orders for admission to the hospital. Very early the next morning, the patient complained to a nurse that he could not move his legs. Morphine was administered, and he slept for seven hours.
When he awoke, a nurse checked his status and reported that the patient was flaccid and paralyzed from the umbilicus down. Dr. S. came to see the plaintiff at about 11:00 am and discovered that he was paralyzed. Dr. S. ordered CT, then changed the order to one for MRI. In the hospital history, Dr. S. dictated that he had directed the patient to report to the ED the previous afternoon, but that he had refused.
The MRI revealed a large epidural abscess. Laminectomy was performed, and the abscess was removed.
The plaintiff never regained function in his legs, bowel, or bladder. He continued to experience spasms that were strong enough to eject him from his wheelchair.
The plaintiff alleged negligence by Dr. S., the hospital, and the ED physicians. The hospital and ED physicians settled for $1.25 million prior to trial.
At trial, the plaintiff claimed that Dr. S. had failed to properly refer him to the ED.
The defendant claimed that even if the plaintiff had been sent to the ED, he might not have undergone MRI and received treatment before paralysis developed. Dr. S. claimed that the hospital physicians and staff had delayed the diagnosis and treatment of the epidural abscess. He also claimed that he had instructed the plaintiff to go to the ED immediately because he might be at risk for paralysis, but the plaintiff had refused. Dr. S. argued that he ordered the blood work and prescribed naproxen only after the plaintiff refused to go to the ED. The plaintiff denied that Dr. S. had told him to go to the ED or risk paralysis.
According to a published account, a verdict of $9,420,840 was returned. Calculation of credit for the settlements and application of the 1975 Medical Injury Compensation Reform Act were pending.
Did Acne Medication Cause IBD?
For four months, a 14-year-old boy was treated with isotretinoin for acne. During this time, he noticed that he had chapped lips and achy knees.