In January 2008, a man presented to the emergency department (ED) of a Florida hospital with complaints of headache and rectal pain. He was seen by Dr. C., who did not perform a rectal exam and discharged the patient with a diagnosis of acute headache.
The following day, the man returned to the ED with right lower quadrant pain. He was evaluated by a PA, who noted painful urination and erythema in the groin. The PA diagnosed dysuria, tinea cruris, and “probable exposure to sexually transmitted disease.”
Two days later, the patient went to the ED again, complaining of severe bilateral abdominal pain, rectal and head pain, and shortness of breath. Dr. N. evaluated him and ordered labwork, including a complete blood count and d-dimer qualitative study, and CT of the pelvis. These revealed an elevated white blood cell count and extensive soft tissue emphysema in the pelvis. The radiologist reported concern about a “perineal soft tissue infectious process” and noted that he and another radiologist had reviewed the findings with an ED physician.
The following morning, Dr. O. assessed the patient and admitted him with a diagnosis of possible cellulitis. The patient was then transferred to another hospital.
The plaintiff filed a lawsuit claiming that he actually had a necrotizing infection and that the delay in diagnosis resulted in the development of disseminated intravascular coagulation with thrombocytopenia. The plaintiff required numerous surgeries and wide local debridement of the tissue of his perineum, scrotum, rectum, and preperitoneum. He developed multiple life-threatening complications, underwent hyperbaric oxygen therapy, endured five months of inpatient care, and required placement of a long-term colostomy.
The plaintiff’s initial claims included many defendants. Several settled for undisclosed amounts; others were dismissed. The action proceeded to trial against hospitalist Dr. O. and his medical practice.
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