Cases compiled from www.verdictslaska.com; Editorials by Rose Clifford, RN, editor

© The Medical-Legal News 2007

ANESTHESIOLOGY

• Defense verdict: A female plaintiff, age 40, was 27 weeks pregnant when she went into premature labor. She was admitted to a hospital where her doctor attempted to stop her labor. The fetus suffered cardiac decelerations and an emergency c-section was warranted. The on-call anesthesiologist decided to use spinal anesthesia for the procedure. Under the anesthesia, the mother became hypotensive and went into respiratory arrest. She was  resuscitated and intubated. The baby was delivered safely, but the plaintive spent the next few days in intensive care. The plaintiff claimed that she developed short-term memory deficits. The plaintiff also claimed that the respiratory arrest was caused by the spinal anesthesia, which was inappropriate because of a fluid overload in the plaintiff’s lungs. The defendant claimed that the mother was a high-risk patient because of her premature labor and age, and the fact that she was obese, diabetic, had a history of smoking and had a short neck.  Johntee and Johntee v. Jefferson, Los Angeles . Defense experts: Dr. Julian Gold, Dr. Michael Gold, Dr. David Paster.

RC: Based on the facts reported, the defense verdict seemed most likely because spinal anesthesia is an appropriate choice in a high risk patient, respiratory arrest is a known risk of spinal anesthesia, the respiratory arrest was immediately recognized and treated appropriately. As a result the plaintiff suffered no permanent damages.

CARDIOLOGY

• Plaintiff verdict: $1 million. Beginning in 1997 the plaintiff’s decedent began to have occasional periods of severe pain in his chest, neck and arms. Over time, these incidents increased in severity and in 1999 the decedent visited a cardiologist, Dr. David L. Williams.

A stress test was administered, which the decedent failed. No follow-up was ordered. The decedent’s pain attacks did not stop and a few months later he returned to the same doctor. He underwent a cardiac catheterization that revealed a 50 percent stenosis of the left anterior descending artery. The doctor, however, did not tell the decedent that his pain was cardiac in origin. Five years later, in 2004, while playing tennis, the decedent had nausea, tightness in his chest and pain radiating down his left arm. He blacked out and CPR was administered. The same cardiologist saw the decedent and diagnosed vasovagal syncope. The decedent died a few months later from an MI. The plaintiff maintained that tests and a better evaluation should have been done in 2004. Nyberg v. Williams, et al. Volusia Co., Fla. Plaintiff expert: Dr. Neil J. Freeman.

RC: Based on the medical sequence of events and resulting test results it seems unlikely that a prudent cardiologist would not have performed an adequate work-up and reasonably diagnosed a cardiac problem. As a result of his failure to perform an adequate cardiac work-up the patient died.

• Plaintiff verdict: $1.8 million. An elderly gentleman underwent a successful triple coronary artery bypass. The next day he developed an atrial fibrillation. The plaintiff converted and remained in normal sinus rhythm for 24 hours and was discharged three days later.  About three days after discharge the plaintiff suffered a massive stroke, which has left him permanently partially paralyzed. He needs 24-hour care, suffers from dementia, depression and mobility problems. Bergeron v. Dartmouth-Hitchcock Clinic, Merrimack Co., N.H. Plaintiff expert: Dr. Ralph Hutchings.

RC: The plaintiff allegation of premature discharge and physician failure to prescribe appropriate medication to prevent stroke seemed reasonable, and except for the malpractice, was preventable.

DENTAL

• Plaintiff arbitration award: $300,000. A 60-year-old woman had been seeing her family dentist since the 1960s.  Over the years the woman had developed chronic progressing periodontitis, but the defendant dentist never told her, treated the disease nor referred her out for treatment. The defendant never took full mouth X-rays nor probed for pocketing depth or bone loss. In 2003 the plaintiff visited another dentist and it was determined that all of her upper teeth would have to be extracted. The defendant claimed that he did refer the plaintiff to specialists, that she was noncompliant and that the plaintiff had poor oral hygiene. Tice v. Heald, Washtenaw Co., Mich.

RC: The common defense of plaintiff noncompliance does not overshadow facts of evident failure over decades to take X-rays, treat a progressive disease or refer to a specialist.

FAILURE TO DIAGNOSE

• Plaintiff settlement: $400,000. A 13-year-old child suffered repeat headaches. In 2002 while at a camp the child’s vision became distorted and she suffered from severe headaches. She died the next day. She died as a result of a brain bleed caused by an undiagnosed aneurysm or other venous malformation. The plaintiffs claimed that the physician failed to properly assess, manage or investigate the headaches. The plaintiff further claimed that a neurological exam and MRI or CT scans could have detected the condition. The defendant, Dr. Keith Staiman, claimed he had done neurological exams and scans, but that they would not necessarily have detected the condition. The doctor also claimed that the condition may not have been treatable, and that the headaches were episodic in nature. Blumenthal v. Staiman, et al. Nassau Co., N.Y. Plaintiff expert: Dr. Allan Hausknecht.

RC: Defense claims of having performed a neurological examination and that not ordering an MRI or CT scan because they would not have necessarily detected the condition does not seem reasonable in view of the death.

• Plaintiff settlement: $6.9 million. A 19-year-old woman was hit by a motor vehicle. She was transported to a hospital and reported that she had severe pain in her lower back. On the third day of her hospitalization she became paraplegic. The plaintiff claimed that she sustained fractures of the lower back which were not diagnosed despite her complaints of severe low back pain. The plaintiff is wheelchair bound and suffers from incontinence. The defendants claimed that the paraplegia was caused by the auto accident and that earlier treatment would not have prevented it. Orlowski v. New York City Health and Hospitals Corp., et al. Queens Co., N.Y. Plaintiff experts: Dr. Jonathan Vapnek, Dr. Jeffrey S. Kaplan, Dr. Dr. Robert Goldberg, Dr. Thomas Kolb, Dr. Marc Salzberg, Dr. Alain Lotbiniere, Dr. Jack Stern.

RC: Defense claims of paraplegia resulting from the initial trauma seems unlikely in view of a three-day hospital stay after being struck by the motor vehicle where there were complaints of severe low back pain and no evidence of paraplegia. Failure to diagnose compression fracture of the thoracic spine seems a more likely cause of damage.

• Plaintiff settlement: $650,000. A woman went to a hospital with complaints of shoulder and neck pain after an auto wreck. X-rays were taken and were deemed to be normal by the ER doctor. The next day the X-rays were read by a radiologist who reported an emerging lung nodule. The radiologist noted that an  evaluation should be done to include full AP and lateral chest films.  A copy of this report was sent to the woman’s primary doctor who saw her two weeks later. The doctor failed to order any X-rays or other studies. The woman returned to her doctor on several occasions over the course of several months, but no studies were performed. The woman died of lung cancer about two years after her original X-ray. The plaintiffs argued that there was a failure of communication, and the fact that the decedent lived for two years indicated that she could have been successfully treated. The defense claimed that the lung cancer was already too far advanced at the time of the initial X-ray. Anonymous v. Anonymous, Essex Co., Mass.

RC: The defendant doctor failed to follow up on the radiologist’s recommendation for additional chest X-rays when he noted an emerging lung nodule on routine X-rays.

• Plaintiff settlement: $4.35 million. A nine-year-old boy began having repeated seizures and fainting spells. After various doctor visits he was always sent home without any cardiac tests. He had a massive heart attack and suffered brain damage from a lack of oxygen. The plaintiff will be bedridden for the rest of his life. The child was deaf and autistic, and the defendants claimed that the child’s disease was so very rare that it was impossible to diagnose, and that the plaintiff’s inability to communicate his condition contributed to the failed diagnosis. John Doe v. Anonymous Healthcare System, Alameda Co., Calif.

RC: Taking a history from an autistic child who cannot hear is next to impossible — all the more reason why a responsible doctor would order cardiac tests.

• Plaintiff settlement: $1.15 m