Birth control change proves fatal
THE WORST HEADACHE SHE EVER HAD brought a 21-year-old woman to the emergency room. She had suffered severe headaches the previous month after switching from Depo-Provera shots to Nordette 28 birth control pills; the headaches went away, then returned.
A month after the ER visit, she visited a family medicine clinic, complaining of headaches, nausea, diarrhea, possible fever, and slight dizziness. A physician assistant prescribed Bactrim DS, Phenergan for the nausea, and Phrenilin for the headache.
Two days later, the patient was taken by ambulance to an ER because of numbness all over, nausea, vomiting, and dizziness. She was discharged, but brought back 4 hours later somnolent, difficult to arouse, and unable to obey commands. A computed tomography (CT) scan and magnetic resonance imaging performed the next morning showed blood clots in the brain, with complete occlusion of the superior sagittal sinus vein, and cerebral herniation.
A few days later, the patient was removed from life support. An autopsy indicated that the cause of death was a recent thrombus of the superior sagittal sinus with bilateral acute cerebral infarcts associated with secondary thrombi of tributary veins.
PLAINTIFF’S CLAIM The defendants were negligent in failing to pay attention to the change in the patient’s birth control regimen and test for cerebral thrombosis, a recognized adverse reaction when switching from shots to pills for birth control.
THE DEFENSE No information about the nature of the defense is available.
VERDICT $7 million North Carolina verdict.
COMMENT If you want to avoid malpractice, make sure you obtain urgent imaging for the patient with the worst headache of his or her life.
“Bronchitis” turns out to be lung cancer
UPPER RESPIRATORY TRACT SYMPTOMS prompted the patient to visit his primary care physician, who diagnosed asthma. Six months later, the patient returned with difficulty breathing and discolored mucus. The doctor diagnosed acute bronchitis and ordered a chest radiograph, which showed a growth in the lung. A subsequent CT scan confirmed the finding and identified a swollen right paratracheal lymph node. The radiologist’s report noted that “neoplasm cannot be entirely excluded.”
A series of radiographs and CT scans over the next several months continued to show the growth, which appeared unchanged. Radiologists’ reports advised that cancer couldn’t be ruled out and recommended further evaluation.
More than a year after the initial radiograph, the patient began to complain of persistent back pain along with the respiratory problems. A pain specialist ordered magnetic resonance imaging of the thoracic spine, which showed that the growth had enlarged. The report noted that the mass “must be considered highly worrisome for metastatic or other tumor unless proven otherwise.” A subsequent biopsy revealed stage IV lung cancer.
PLAINTIFF’S CLAIM If the defendant had investigated the growth at the time of the first radiograph, the cancer might have been curable.
DOCTOR’S DEFENSE The lung cancer was caused by the patient’s smoking, and the physician had tried unsuccessfully to get the patient to quit. The doctor did what the radiologists recommended after each CT scan and radiograph. The cancer wasn’t diagnosed earlier because a second scan failed to note that the right lymph node was still enlarged.
VERDICT $3 million Pennsylvania verdict.
COMMENT Failure to aggressively follow up—and diagnose—lung masses is a common malpractice pitfall.