Cases compiled from www.verdictslaska.com;
Editorials by Rose Clifford, editor
• Defense verdict: A 63-year-old man underwent bypass surgery. A month later an angioplasty was performed on the man because of continuing complaints of pain. During this second operation a stent perforated and dissected an artery graft, resulting in death. The plaintiff claimed that the second procedure should not have been done, and that a “redo” bypass surgery should have been performed on the small bypass artery that was allegedly causing the symptoms of pain. The defendants maintained that the arteries in the second angioplasty procedure were chosen because they were the correct ones to improve blood flow, and that the bypass artery was too small for angioplasty and stenting. The defendants also claim that the decedent was not a candidate for another bypass because there was not enough time to prepare him and obtain a cardiothoracic surgery consult. There also was a high probability that a second bypass would fail. (Lane v. Stephenson and Stoler, Dallas County, Texas). Plaintiff expert: Stephen Hubbard, MD. Defendant experts: Andrew T. Hume, MD, Sam Woolbert, MD.
• RC: The defendants likely were correct in their strategy. Issues to consider, research and evaluate are: 1) Perforation of a coronary artery is a known risk of the angioplasty procedure, but was it a complication or operator error? 2) Were the plaintiff’s complaints of ongoing pain one month post-bypass surgery of a nature and magnitude that necessitated an angioplasty so soon, or was the pain normal post-op pain that was under treated; and 3) were the chosen vessels for the angioplasty the anatomically correct vessels to improve blood flow to artery causing the complaints of pain?
• Defense verdict. A 46-year-old woman underwent a root canal. The woman claimed that the dental assistant instructed her to rinse her mouth using a cup near a sink. The plaintiff claimed that the cup contained bleach, and claimed that after rinsing with the bleach she lost her sense of taste on most of her tongue and suffered from dry mouth, as well as burning and pain in her mouth. The defendant dentist held that the plaintiff got out of her chair without permission and grabbed a cup near the sink without being told to do so. The defendant admitted that the cup contained a small amount of bleach and that the plaintiff immediately spit out the contents of the cup and rinsed her mouth with water. The defense also argued that there was no objective medical evidence supporting the plaintiff’s claims. (Alvarez v. Roisman, Dental Plus and Malakzad, Los Angeles). Plaintiff experts: George Bernard, DDS, Robert McNamara, DDS. Defense experts: Edwin C. Amos, III, MD, Barton Kubelka, DDS, Larry J. Moore, DDS, Shane White, DDS.
RC: Although the plaintiff believes the injuries are great, they seem small, almost negligible, to a jury. When evaluating such claims it is vital to identify any objective evidence that would support the claim. Hiring appropriate experts such as a general dentist, endodontist, a neurologist, ENT (ear, nose, throat specialist) and perhaps an oral surgeon, would be advisable.
• $2 million settlement: A 52-year-old man underwent surgery to remove an abscessed tooth at a dental facility. The surgery was performed by a dental surgeon who was assisted by employees of the dental facility. The plaintiff patient received sedation by IV in the right arm. After the surgery, but before the man awakened, a bolus shot of Cleocin, an antibiotic, was injected into the right arm by an assistant per the surgeon’s order. When the plaintiff awoke he complained of an intense burning sensation in the arm and was taken to an ER. It was determined that compartment syndrome had developed and within five days the arm had to be amputated. The plaintiff claimed that the Cleocin was administered by an assistant who was unlicensed to give injections, and that the Cleocin should have been diluted and given through an IV drip. The defendants argued that the antibiotic was given properly and that while the compartment syndrome was the reason for the amputation, it was unrelated to the administration of the antibiotic. (Murphy, et al v. Weinstein, Monarch Dental and Bright Now! Dental, Dallas County, Texas). Plaintiff experts: Donald F. Cohen, DDS, Gary H. Wimbish, PhD. Defense experts: Robert Campbell, DDS.
• RC: Loss of a right arm is a horrific result from surgery for an abscessed tooth. Considerations of potential contributing issues in evaluating this kind of case would be to 1) identify the standard of care for IV administration of the antibiotic, 2) scrutinize the care given in the ER for possible causes of the injury, and 3) analyze the five days leading up to the amputation.
• $804,128 verdict. A 51-year-old woman presented to a hospital after suffering a syncopal episode at home, which began with nausea. Later that evening at the hospital she had another syncopal episode along with nausea and vomiting. The next day the defendant cardiologist did a cardiac consultation and concluded that the plaintiff had sick sinus syndrome and required a pacemaker. The pacemaker was put in the next day, but after the surgery the plaintiff experienced pain in her right chest and went to see other cardiologists. It was later determined that the plaintiff had vasovagal syncope rather than the sick sinus syndrome — so the pacemaker was not needed. The pacemaker was removed, but the leads were left in the heart tissue to avoid any further problems. The plaintiff claimed that because of the defendant’s negligence she had undergone two unnecessary procedures. Additionally, the plaintiff complained of pain in her chest because of the embedded pacemaker leads. The defense argued that the diagnosis made was reasonable because there were several pauses in the plaintiff’s heart rhythm that were unaccompanied by vagal triggers. Lazarski v. Ishkan, Cook County, Ill.).
• RC: Vasovagal syncope is fainting due to stimulation of the vagus nerve. Missed diagnoses are common. Nurses are trained to correlate signs and symptoms to diseases and to question the physician if the signs and symptoms are inconsistent with the diagnosis. This is a simple case that seems complicated because of the medical terms. A nurse consultant would be able to explain the medical terms in lay words, identify criteria for needing a pacemaker and be able to point out the subtle differences between a vasovagal syncope versus sick sinus syndrome and how the medical record supports the diagnosis. There may be more to the doctor’s misdiagnosis than meets the eye, such as underlying financial gain. This is another area of potential investigation.
• Defense verdict: The plaintiff, a young woman pregnant with twins, was involved in a car crash and suffered a broken pelvis. She also had been hospitalized at least six times during her pregnancy for excessive vomiting. Late in her pregnancy she fell down a flight of stairs. The day after the fall she went to an emergency room. A PICC line was inserted to deliver fluids and medicines. The line evidently came out, but was reinserted by the radiologist on staff. The next day the woman went into labor. The plaintiffs claimed that the emergency room doctor failed to note that her water had broken and that she was about to deliver prematurely. Both infants died, and one was delivered into a toilet. The plaintiffs claimed that the reinsertion of that PICC line caused an infection that led to the premature delivery and death of the babies. The plaintiffs also asserted that the mother should have been sent to the labor and delivery room in a more timely fashion. The defense argued that their care was not related to the death of the twins and insisted that the mother had multiple risk factors — she had smoked during the pregnancy, used drugs prior to her knowledge that she was pregnant, was under age 20, had lost an earlier pregnancy, had suffered bleeding during the first trimester and had suffered repeated traumatic injuries and excessive vomiting. The defendants also noted that there was only one placenta and amniotic sac for the twins, and that the infants had twin-to-twin transfusion, which has a high mortality rate. (Brant, et al v. Maesaka, et al, Elkhart County, Ind.). Plaintiff’s expert: Alan Gillespie, MD.
• RC: Although loss of twin babies is tragic, remain objective by reviewing and taking into consideration all the pre-existing medical facts, any influencing social behaviors, the medical sequence of events, basic anatomy and the underlying pathophysiology. Add to the review any potential jury reactions to the case facts. No matter the case, the jury reaction to the plaintiff’s use of drugs and smoking, especially when pregnant, is viewed unfavorably. True pathophysiology is impossible to overcome.
• $1.9 million verdict: A 70-year-old woman had a history of cardiac disease, including a cardiac bypass and an aortic aneurysm. She experienced severe chest pain, so her son took her to an emergency room. There, the triage nurse did an initial evaluation. The woman was initially evaluated as “emergent,” but after the nurse was told that the woman had been vomiting earlier in the day the woman was downgraded to “urgent” and sent back to the waiting area. From 15 to 45 minutes passed and the woman’s symptoms worsened, which provoked the son to demand help. The son became belligerent and loud and security was called. While security was restraining the son, the woman collapsed. The woman was taken to a room where resuscitation was attempted, but the woman died. The plaintiff’s claim was that the hospital failed to follow its own advanced triage protocols, which would have resulted in the deceased woman being treated for her heart arrhythmia. The plaintiffs argued that such treatment would have prevented the death. The defendant hospital maintained that the decedent did not complain of chest pain, but reported a history of abdominal pain. This defense was consistent with post-mortem findings of a bowel obstruction. The hospital held that it was reasonable not to treat the woman immediately and that her demise was due to sudden cardiac death. The plaintiffs countered that under the hospital’s own protocol a person with complaints of abdominal pain and a history of aortic aneurysm would require immediate assessment by a doctor and placement on an EKG machine. (Tate, et al v. Barnes Jewish Hospital, St. Louis, Mo.). Plaintiff expert: William Yates, MD. Defense experts: Donald Miller, MD, Michael Weaver, MD.
• RC: Here, outrageous treatment of a family member is witnessed while he is merely seeking emergent medical help for another family member who is obviously ill. The witnessing augments the repeated violations of the facility’s own protocols, which clearly link the breach in the standard of care — and that breach directly results in damages. Cases of maltreatment in emergency care are always worth pursuing. Issues to anticipate are other reasonable explanations for the damages, explanations that are not true and the argument that the damages were unrelated to the breach. Developing counter arguments is most helpful.
• Defense verdict: A 32-year-old woman began experiencing burning and frequency of urination. The plaintiff went to the defendant doctor and claimed that the doctor failed to diagnose a kidney infection or kidney stones, and failed to timely refer her to a urologist. The plaintiff asserted that by the time a proper diagnosis was made her kidney had been permanently damaged and required surgical removal. The plaintiff insisted that her symptoms were treated as a simple bladder infection with antibiotics, but the infection never subsided. The plaintiff argued that the infection was present for over two years before a large staghorn kidney stone was finally detected by intravenous pyelogram (IVP). The defendant doctor maintained that the plaintiff’s complaints were not consistent with a severe infection and that simple bladder infections, which are common in women, are treated with antibiotics. The defendant claimed that the woman had multiple, simple infections, not one continuous infection, and also contended that the plaintiff was given two separate referrals for an IVP test in the year before the kidney stone diagnosis. Had the plaintiff gone for the tests, any stone likely would have been diagnosed before the kidney damage. (Michalek v. Crawford, Jefferson County, Mo.). Plaintiff experts: Carlos Deleste, MD, William Fish, MD. Defense expert: John Daniels, MD.
• RC: There are three main issues in this case that should have been anticipated from a consulting perspective whether plaintiff or defense: 1) medical documentation via a timeline that would support whether or not the infection was one continuous infection or a series of infections, 2) identification of any evidence of referral for the IVP and 3) whether or not the plaintiff followed her physician’s order for the IVP. Also ask if the plaintiff can live a reasonably normal life with the loss of one kidney. Infection cases are difficult to prove. Patient noncompliance is hard to overcome and a normal life with one kidney is feasible.
Pyelogram: A radiograph of the ureter and renal pelvis.
Intravenous pyelogram (IVP): A pyelogram in which a radiopaque material is given intravenously. Radiographs of the urinary tract taken while material is excreted provide information about the structure and function of the renal system. This examination may be used to detect kidney stones and other lesions.
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