Had C difficile cleared before chemotherapy?
THE DIAGNOSIS WAS BREAST CANCER for a 54-year-old woman. In May 2006, a surgeon performed a mastectomy and prescribed postoperative antibiotics.
In July, the patient became ill and was treated for Clostridium difficile infection. She began a course of chemotherapy in August, after telling her oncologist about the earlier infection. The patient later developed acute colitis and underwent emergency colectomy. She has a permanent ileostomy, has had 14 additional operations, and continues to suffer complications of severe colitis.
PATIENT’S CLAIM The surgeon was at fault for prescribing antibiotics after mastectomy. The oncologist was negligent in failing to test for C difficile before starting chemotherapy. The antibiotics caused C difficile infection. Because her immune system was compromised by chemotherapy, C difficile caused colitis.
PHYSICIANS’ DEFENSE The surgeon’s defense was not reported. The oncologist claimed he was not negligent; he questioned whether the patient had C difficile infection at all.
VERDICT The surgeon settled for an undisclosed amount before trial. A $4.5 million Oklahoma verdict was returned against the oncologist.
Uterine rupture and placental abruption found at C-section
A WOMAN WAS IN ACTIVE LABOR at 41 weeks’ gestation when admitted to the hospital. After 9 hours of labor, cesarean delivery was performed because the fetal heart-rate tracing showed tachycardia, with potential fetal distress.
At delivery, it was discovered that the uterus had ruptured and the placenta had abrupted. The child was asphyxic and bradycardic at birth. She suffered brain damage that resulted in severe cognitive deficits and cerebral palsy. At 5 years, she is unable to speak, walk, sit up, or feed herself.
PATIENT’S CLAIM Although the fetal heart-rate tracing showed fetal distress, several hours passed before cesarean delivery was performed. Oxytocin should not have been administered during labor because the drug is contraindicated in the presence of an abnormal fetal heart rate.
DEFENDANTS’ DEFENSE Hospital physicians and staff reacted properly and in a timely manner when the heart-rate tracing showed fetal distress. Uterine rupture and placental abruption could not have been foreseen.
VERDICT A $5.8 million Texas settlement was reached.
Fibrocystic mass becomes cancerous
A WOMAN UNDERWENT regular annual breast exams because of fibrocystic breast disease. Her primary care physician noted a breast mass in 1997, and continued to follow the mass. A biopsy in 1999 revealed fibrosis. In January 2002, breast cancer was diagnosed in the same mass, and the woman underwent mastectomy.
PATIENT’S CLAIM The physician was negligent in failing to diagnose breast cancer earlier. She had classic signs of cancer, including a persistent mass with changing symptoms.
PHYSICIAN’S DEFENSE The mass had been closely monitored, so that when changes were noted in December 2001, a referral was made and cancer diagnosed.
VERDICT A Louisiana defense verdict was returned.
Was mother’s labor monitored properly?
DURING DELIVERY, a woman experienced vaginal bleeding without pain or contractions. The nurses did not consider the bleeding excessive and did not detect any urgency to her labor until several hours later. The baby did not survive, and it was determined the mother suffered from vasa previa. She had been given a diagnosis of placenta previa at 15 weeks, but a sonogram at 20 weeks showed resolution.
PATIENT’S CLAIM The mother’s condition should have been monitored more closely. Vaginal bleeding during labor and delivery should have been responded to more urgently, given the history of placenta previa.
DEFENDANTS’ DEFENSE The hospital and the nurses claimed that the woman was properly treated.
VERDICT An Alabama defense verdict was returned.
Heart attack and death after epidural
AT AGE 34, A WOMAN WENT to the hospital for cesarean delivery of her third child. Within minutes of receiving epidural anesthesia, she became agitated and complained of difficulty breathing. She went into cardiopulmonary arrest, and resuscitation efforts were unsuccessful. The child survived.
ESTATE’S CLAIM A total spinal block occurred; the anesthesiologist failed to recognize and treat it in a timely manner.
PHYSICIAN’S DEFENSE Medications were properly administered; a total spinal block had not occurred. The patient had a history of Hodgkin’s lymphoma with chemotherapy, and radiation treatment of the chest. Autopsy indicated the cause of death was Castleman’s disease, a rare lymphoproliferative disease, which had not been diagnosed during her life.
VERDICT A $800,000 Virginia verdict was returned.
Retained sponge causes obstruction
AFTER CESAREAN DELIVERY, the nurses reported a complete sponge count. Immediately after surgery, the mother reported lower-left quadrant pain that resolved, then recurred. Several complaints to her ObGyn were dismissed. After 2.5 months, the ObGyn referred the patient to her primary care physician. An abdominal CT scan revealed a retained surgical sponge, with bowel perforation. The ObGyn attempted surgery, but the sponge was partially adhered to bowel. Colorectal surgeons had to resect two sections of small intestine to remove the infected sponge and abscess. She continues to have medical problems and has been hospitalized for an obstruction.