MEDICOLEGAL ISSUES Section Editor: Steven M. Selbst, MD
Pediatric Emergency Medicine Legal Briefs
Key Words: lawsuit, legal briefs, malpractice, misdiagnosis
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7-year-old boy from Mississippi underwent a tonsillectomy and adenoidectomy in January, 2008.1 During intubation by the anesthesiologist before surgery, 1 of the boy’s teeth was dislodged and could not be located. It was believed that the tooth had been swallowed. The surgery was performed. When it was concluded, the patient’s stomach was suctioned, but the tooth was not found. An x-ray examination revealed that it had been aspirated into the right main stem bronchus. The child was kept under anesthesia and transported to a children’s hospital where he underwent a second surgery to retrieve the tooth. He was in the pediatric intensive care unit briefly but had a complete recovery. The patient and his family sued the anesthesiologist and alleged negligence infailing to extract the loose tooth or securing the tooth to prevent aspiration. The defendant anesthesiologist claimed that the retrieval was uneventful and that the patient experienced no harm and had no discomfort during the transfer and removal procedure. The physician maintained that it was a matter of judgment as to whether or not a tooth is an unreasonable risk. A jury found in favor of the physician. Harrison County, Mississippi Circuit Court, Case No. 8Y274.
EDITOR’S COMMENTS Though not a case from the emergency department (ED), many emergency physicians have had fears of dislodging a tooth during intubation, and perhaps some have had similar bad luck with the tooth ending From the Division of Emergency Medicine, Nemours/ Alfred I. duPont Hospital for Children, Wilmington, DE; and Jefferson Medical College, Philadelphia, PA. Disclosure: The author declares no conflict of interest. Reprints: Steven M. Selbst, MD, Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Jefferson Medical College, Philadelphia, PA (e-mail: [email protected]). Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0749-5161 DOI: 10.1097/PEC.0000000000000056
Pediatric Emergency Care
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up in the trachea. Fortunately, the jury recognized that this was a possible complication of intubation and that the patient did not experience severe harm.
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young woman from New York developed pain in her abdomen and back in September 2008.2 She went to the ED of a local hospital, and after evaluation, it was believed her pain was related to a kidney stone. Oxycodone/acetaminophen was prescribed, and she was instructed to return to the ED if she developed a fever or if the analgesic did not relieve her pain. The patient’s symptoms continued, and she called an ambulance a few hours later. The ambulance crew noted that she had fever, and acetaminophen was administered. The patient was not transported back to the hospital. Instead, she signed a document saying that she had refused transport. About 10 hours later, an ambulance was called again. The patient then reported numbness of her lips and toes and thought she was experiencing adverse effects from the oxycodone/ acetaminophen medication. The ambulance crew found no abnormal vital signs, and again, she was not transported to the hospital. She again signed a document, which indicated that she refused medical assistance. An hour later, the patient was brought back to the ED, and her condition was diagnosed with septic shock due to kidney stone, urinary reflux, and urosepsis. She developed disseminated intravascular coagulopathy, which caused necrosis of her extremities, ultimately leading to the amputation of her feet and hands. The patient also experienced near-total loss of vision in the left eye due to a neuropathy. The patient sued the ambulance crews and the ED who evaluated her initially. She claimed that prompt treatment of her kidney stone would have prevented the sepsis. She contended that when she signed the forms regarding refusal of treatment by the paramedics, she believed that she was simply acknowledging that she was treated. The defendant ED physicians and paramedics claimed that the patient was properly treated and alternative treatments presented risks that could have worsened her condition. A $17.9 million settlement was reached, which included $8.5 million from the city,
Volume 29, Number 12, December 2013
$5 million from the hospital, and $4.4 million from the physicians. Kings County, New York Supreme Court, Index No. 6162/09.
EDITOR’S COMMENTS It is not clear if there was a language barrier here, and we do not know what was explained to the patient when the paramedics arrived at her home. Regardless of her condition, it is mystifying why she was not transported to a hospital with her persistent symptoms and after calling for help twice. Although many facts are missing, it is also unclear why the emergency physicians were found negligent. Home management of a kidney stone, with good instructions about when to return, seems like reasonable care.
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2-year-old girl from Washington, DC had difficulty of breathing in February 2010, and her mother called 911.3 Emergency Medical Services personnel were dispatched to the home, but the paramedics did not transport the child to a hospital. Allegedly, they instructed the mother to treat the toddler’s congestion at home with steam. Several hours later, the girl had persistent breathing difficulty, and her mother again called 911. The child was transported to a hospital this time, but she died the next day. An autopsy found the cause of death to be complications from pneumonia. The family sued the paramedics and claimed that the personnel who responded to the first call should have transported the child and that a proper examination was not made. The defendant paramedics claimed that the girl’s mother chose not to transport the child. A $199,500 settlement was reached. District of Columbia Supreme Court, Case No. 2010CA0007232M.
EDITOR’S COMMENTS Why would a mother refuse transport for her child after calling 911? Why would paramedics not transport a patient to the hospital once they arrive at the patient’s home with complaints of difficulty of breathing? It seems that it would be easier to transport than to evaluate a child and try www.pec-online.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Pediatric Emergency Care
Legal Briefs
to convince a family that emergency care is unnecessary. Allegedly, in this case, the paramedics made a diagnosis and prescribed treatment, which may have been beyond the scope of their training.
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mother from Georgia took her 6month-old son to a nearby ED in March 2001 because the baby had diarrhea.3 The ED records indicated that the infant’s abdomen was soft, not tender or distended, and that there were positive bowel sounds. The child was diagnosed with colic and a mild respiratory tract infection. He was prescribed medications to treat gas and cold symptoms and then discharged to home. The next evening, the infant was brought back to the ED after vomiting multiple times. A pediatrician evaluated the baby in the ED, diagnosed her condition with gastroenteritis, and prescribed promethazine. The mother was instructed to use half of 1 of the 12.5-mg suppositories every 12 hours for 3 days. A half of 1 suppository was administered that night. The next morning, the infant stopped breathing and was transported by ambulance to an academic medical center. He was pronounced dead soon after arrival. The family sued and claimed the prescription for promethazine was negligent because the drug was never approved for use in children younger than 2 years. They also initially claimed that the child’s respiratory problems were due to the promethazine but alternatively claimed that the child should have been kept in the hospital for observation. The defendant physician and hospital claimed that the prescription of promethazine was acceptable and maintained that the drug would have been out of the infant’s system at the time he stopped breathing. They argued that an autopsy showed the cause of death to be sepsis and primary peritonitis. A jury found in favor of the physicians and the hospital. Bibb County, Georgia State Court, Case No 053227.
EDITOR’S COMMENTS Much information is missing, and it is not clear if more should have been done for the baby who vomited multiple times before the second ED visit. Warning labels indicate that promethazine may interfere with breathing, may cause death in children, and should not be prescribed to children younger than 2 years. It is surprising that the physicians successfully defended this case. Either a dangerous medicine was prescribed that led to the patient’s death or the diagnosis was missed.
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17-year-old girl underwent a routine tonsillectomy in March 2012 at a hospital in Pennsylvania.4 After the procedure, she was administered fentanyl for pain. Allegedly, the girl was in respiratory distress in the recovery room, and this was not noticed until she was pulseless. She died 15 days later. The patient’s family sued and claimed that the teenaged girl was left unmonitored by 1 of the nurses and that the monitoring equipment was either not working or not properly set. A $6 million settlement was reached. Montgomery County, Pennsylvania Common Pleas Court, Case No. 2012Y10888.
EDITOR’S COMMENTS This case reminds us to worry every time we treat a patient with analgesics and sedatives, even for ‘‘routine’’ situations. Careful monitoring is always essential.
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9-year-old boy from Mississippi underwent a tonsillectomy in July 2001.5 Four days later, the child was brought back to the hospital with complaints of vomiting when he attempted to eat or drink. He was found to be dehydrated. While at the hospital, the child began to cough and had significant oral bleeding. He developed cardiac arrest and could not be resuscitated. An autopsy concluded that an injury to the jugular vein had occurred during surgery, and this led to postoperative bleeding and to his death. The family sued and claimed that the surgeon caused the jugular vein injury while removing the right tonsil. The surgeon claimed that there was no jugular vein injury during the surgery and that the jugular vein injury found at autopsy occurred during the code response. The defendant physician also claimed that the death was related to a blood clot, which had dislodged when the child was coughing. The blood clot then traveled to his lungs causing the death. Initially, a jury found in favor of the physician in 2007, but the case was appealed. A second trial was held in 2011. This ended with a hung jury, and a mistrial was declared. The matter was tried for a third time (12 years after the incident) resulting in a verdict that favored the physician. The defendant surgeon apparently used different pulmonary medicine and otolaryngology experts for the third trial. Lafayette County, Mississippi Circuit Court, Case No. 02Y186.
EDITOR’S COMMENTS Postoperative bleeding after tonsillectomy and adenoidectomy is always a worrisome chief complaint. This is a
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tragic case, and it seems that it was very difficult to truly determine what caused the patient’s death.
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4-month-old infant was transported to a New York ED in August 1995.6 The mother reported that the infant had stopped breathing while sleeping. A physician evaluated the boy and reached the opinion that the child had choked. He was discharged from the ED. In October 1995, the infant was brought back to the hospital, and the mother reported another episode of apnea during sleep. A physician evaluated him and believed that the incident was a ‘‘benign episode of deep respiration.’’ Later in October 1995, the infant was again brought back to the hospital because of another episode of apnea during sleep. At this time, it was determined that the event had caused hypoxic brain damage. The child survived with spastic quadriplegia. He requires a wheelchair, and will need lifelong care. The patient and his family sued the ED and claimed that the hypoxic event was actually sleep apnea that should have been diagnosed at the first examination. They maintained that the infant should have been provided treatment at the previous ED visits, which would have prevented the hypoxic event. The defendant physicians and hospital claimed that the symptoms reported by the mother did not suggest sleep apnea and that the infant did not experience this condition. A $7 million settlement was reached. Bronx County, New York Supreme Court, Index No. 15088/96.
EDITOR’S COMMENTS Without all the details, one cannot be critical of the management of this case. However, benign episode of ‘‘deep respiration’’ is a bold diagnosis when a baby presents with apnea. It is surprising that the baby was not admitted for diagnostic studies with the recurrent complaint of apnea.
A
20-year-old woman, who was 25 weeks pregnant, presented to a California ED in November 2008 for dysuria.7 Allegedly, she also complained of abdominal pain and back pain, but this was denied by the physician who treated her. A urinalysis was performed, and the patient was diagnosed with a urinary tract infection. She was prescribed with cephalexin and instructed to follow-up with her primary care physician. The next morning, the patient went to the labor and delivery unit of a hospital, where she was determined to be in labor and already 8 cm dilated. An emergency cesarean delivery was performed. The baby weighed * 2013 Lippincott Williams & Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Volume 29, Number 12, December 2013
1.75 lb at birth and had severe respiratory complications. The infant was diagnosed with a patent ductus arteriosus and developed intraventricular hemorrhage 5 days after birth. The infant also experienced hypoxic ischemic encephalopathy, causing severe brain damage. She has received treatment at a chronic care facility. The baby’s mother sued the emergency physician and the group who employed her and alleged that the doctor failed to diagnose preterm labor. She claimed that an obstetrician should have been consulted, and had she been transferred to a labor and delivery unit, she would have received treatment to stop her labor. The defendant emergency physician claimed that the mother had only complained of pain during urination and that she gave conflicting accounts when she returned to the hospital the next morning. Allegedly, she told a nurse that her back pain began after her initial discharge from the ED and told other personnel that she had complained of back and abdominal pain during her initial visit. The doctor also claimed that the mother’s preterm labor was not related to the urinary tract infection but was due to the patient having a shortened cervix. A jury found in favor of the ED physician. Los Angeles County, California Superior Court, Case No. MC021601.
* 2013 Lippincott Williams & Wilkins
EDITOR’S COMMENTS It is not clear if earlier diagnosis would have changed the outcome in this case. It is assumed that the emergency physician asked about pain (abdominal and back), and it is likely that the physician was able to defend the case because of proper documentation.
A
woman from Tennessee experienced difficulty breathing in October 2007 and called 911.8 An ambulance arrived, and the patient was transported to a nearby hospital. During transport, 2 straps on the gurney were secured, but a third strap was not. The ambulance driver made a sharp turn during transport. The patient was jostled on the journey, and her leg was bumped causing it to bleed. Because the patient was diabetic, the leg wound was slow to heal. Her leg was later amputated below the knee. The woman died 2 years later. The family sued the ambulance company and alleged that she had diminished enjoyment of life after the ambulance incident. They alleged negligence in failing to properly secure the patient. The defendant ambulance company denied any negligence. A judge found the ambulance company negligent, and the court awarded the family $232,091. An appeal was pending.
Legal Briefs
Monroe County, Tennessee Circuit Court, Case No. 08Y336.
EDITOR’S COMMENTS This is a terrible outcome and an almost unbelievable scenario. Things just continued to get worse after what seemed like a very minor omission. It is hard to believe something so minor could lead to consequences so major.
REFERENCES 1. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:3. 2. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:11Y12. 3. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:12. 4. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:15. 5. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:26. 6. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:6. 7. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:12. 8. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:11.
www.pec-online.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Pediatric Emergency Medicine Legal Briefs
Key Words: lawsuit, legal briefs, malpractice, misdiagnosis
A
7-year-old boy from Mississippi underwent a tonsillectomy and adenoidectomy in January, 2008.1 During intubation by the anesthesiologist before surgery, 1 of the boy’s teeth was dislodged and could not be located. It was believed that the tooth had been swallowed. The surgery was performed. When it was concluded, the patient’s stomach was suctioned, but the tooth was not found. An x-ray examination revealed that it had been aspirated into the right main stem bronchus. The child was kept under anesthesia and transported to a children’s hospital where he underwent a second surgery to retrieve the tooth. He was in the pediatric intensive care unit briefly but had a complete recovery. The patient and his family sued the anesthesiologist and alleged negligence infailing to extract the loose tooth or securing the tooth to prevent aspiration. The defendant anesthesiologist claimed that the retrieval was uneventful and that the patient experienced no harm and had no discomfort during the transfer and removal procedure. The physician maintained that it was a matter of judgment as to whether or not a tooth is an unreasonable risk. A jury found in favor of the physician. Harrison County, Mississippi Circuit Court, Case No. 8Y274.
EDITOR’S COMMENTS Though not a case from the emergency department (ED), many emergency physicians have had fears of dislodging a tooth during intubation, and perhaps some have had similar bad luck with the tooth ending From the Division of Emergency Medicine, Nemours/ Alfred I. duPont Hospital for Children, Wilmington, DE; and Jefferson Medical College, Philadelphia, PA. Disclosure: The author declares no conflict of interest. Reprints: Steven M. Selbst, MD, Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Jefferson Medical College, Philadelphia, PA (e-mail: [email protected]). Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0749-5161 DOI: 10.1097/PEC.0000000000000056
Pediatric Emergency Care
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up in the trachea. Fortunately, the jury recognized that this was a possible complication of intubation and that the patient did not experience severe harm.
A
young woman from New York developed pain in her abdomen and back in September 2008.2 She went to the ED of a local hospital, and after evaluation, it was believed her pain was related to a kidney stone. Oxycodone/acetaminophen was prescribed, and she was instructed to return to the ED if she developed a fever or if the analgesic did not relieve her pain. The patient’s symptoms continued, and she called an ambulance a few hours later. The ambulance crew noted that she had fever, and acetaminophen was administered. The patient was not transported back to the hospital. Instead, she signed a document saying that she had refused transport. About 10 hours later, an ambulance was called again. The patient then reported numbness of her lips and toes and thought she was experiencing adverse effects from the oxycodone/ acetaminophen medication. The ambulance crew found no abnormal vital signs, and again, she was not transported to the hospital. She again signed a document, which indicated that she refused medical assistance. An hour later, the patient was brought back to the ED, and her condition was diagnosed with septic shock due to kidney stone, urinary reflux, and urosepsis. She developed disseminated intravascular coagulopathy, which caused necrosis of her extremities, ultimately leading to the amputation of her feet and hands. The patient also experienced near-total loss of vision in the left eye due to a neuropathy. The patient sued the ambulance crews and the ED who evaluated her initially. She claimed that prompt treatment of her kidney stone would have prevented the sepsis. She contended that when she signed the forms regarding refusal of treatment by the paramedics, she believed that she was simply acknowledging that she was treated. The defendant ED physicians and paramedics claimed that the patient was properly treated and alternative treatments presented risks that could have worsened her condition. A $17.9 million settlement was reached, which included $8.5 million from the city,
Volume 29, Number 12, December 2013
$5 million from the hospital, and $4.4 million from the physicians. Kings County, New York Supreme Court, Index No. 6162/09.
EDITOR’S COMMENTS It is not clear if there was a language barrier here, and we do not know what was explained to the patient when the paramedics arrived at her home. Regardless of her condition, it is mystifying why she was not transported to a hospital with her persistent symptoms and after calling for help twice. Although many facts are missing, it is also unclear why the emergency physicians were found negligent. Home management of a kidney stone, with good instructions about when to return, seems like reasonable care.
A
2-year-old girl from Washington, DC had difficulty of breathing in February 2010, and her mother called 911.3 Emergency Medical Services personnel were dispatched to the home, but the paramedics did not transport the child to a hospital. Allegedly, they instructed the mother to treat the toddler’s congestion at home with steam. Several hours later, the girl had persistent breathing difficulty, and her mother again called 911. The child was transported to a hospital this time, but she died the next day. An autopsy found the cause of death to be complications from pneumonia. The family sued the paramedics and claimed that the personnel who responded to the first call should have transported the child and that a proper examination was not made. The defendant paramedics claimed that the girl’s mother chose not to transport the child. A $199,500 settlement was reached. District of Columbia Supreme Court, Case No. 2010CA0007232M.
EDITOR’S COMMENTS Why would a mother refuse transport for her child after calling 911? Why would paramedics not transport a patient to the hospital once they arrive at the patient’s home with complaints of difficulty of breathing? It seems that it would be easier to transport than to evaluate a child and try www.pec-online.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Pediatric Emergency Care
Legal Briefs
to convince a family that emergency care is unnecessary. Allegedly, in this case, the paramedics made a diagnosis and prescribed treatment, which may have been beyond the scope of their training.
A
mother from Georgia took her 6month-old son to a nearby ED in March 2001 because the baby had diarrhea.3 The ED records indicated that the infant’s abdomen was soft, not tender or distended, and that there were positive bowel sounds. The child was diagnosed with colic and a mild respiratory tract infection. He was prescribed medications to treat gas and cold symptoms and then discharged to home. The next evening, the infant was brought back to the ED after vomiting multiple times. A pediatrician evaluated the baby in the ED, diagnosed her condition with gastroenteritis, and prescribed promethazine. The mother was instructed to use half of 1 of the 12.5-mg suppositories every 12 hours for 3 days. A half of 1 suppository was administered that night. The next morning, the infant stopped breathing and was transported by ambulance to an academic medical center. He was pronounced dead soon after arrival. The family sued and claimed the prescription for promethazine was negligent because the drug was never approved for use in children younger than 2 years. They also initially claimed that the child’s respiratory problems were due to the promethazine but alternatively claimed that the child should have been kept in the hospital for observation. The defendant physician and hospital claimed that the prescription of promethazine was acceptable and maintained that the drug would have been out of the infant’s system at the time he stopped breathing. They argued that an autopsy showed the cause of death to be sepsis and primary peritonitis. A jury found in favor of the physicians and the hospital. Bibb County, Georgia State Court, Case No 053227.
EDITOR’S COMMENTS Much information is missing, and it is not clear if more should have been done for the baby who vomited multiple times before the second ED visit. Warning labels indicate that promethazine may interfere with breathing, may cause death in children, and should not be prescribed to children younger than 2 years. It is surprising that the physicians successfully defended this case. Either a dangerous medicine was prescribed that led to the patient’s death or the diagnosis was missed.
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www.pec-online.com
A
17-year-old girl underwent a routine tonsillectomy in March 2012 at a hospital in Pennsylvania.4 After the procedure, she was administered fentanyl for pain. Allegedly, the girl was in respiratory distress in the recovery room, and this was not noticed until she was pulseless. She died 15 days later. The patient’s family sued and claimed that the teenaged girl was left unmonitored by 1 of the nurses and that the monitoring equipment was either not working or not properly set. A $6 million settlement was reached. Montgomery County, Pennsylvania Common Pleas Court, Case No. 2012Y10888.
EDITOR’S COMMENTS This case reminds us to worry every time we treat a patient with analgesics and sedatives, even for ‘‘routine’’ situations. Careful monitoring is always essential.
A
9-year-old boy from Mississippi underwent a tonsillectomy in July 2001.5 Four days later, the child was brought back to the hospital with complaints of vomiting when he attempted to eat or drink. He was found to be dehydrated. While at the hospital, the child began to cough and had significant oral bleeding. He developed cardiac arrest and could not be resuscitated. An autopsy concluded that an injury to the jugular vein had occurred during surgery, and this led to postoperative bleeding and to his death. The family sued and claimed that the surgeon caused the jugular vein injury while removing the right tonsil. The surgeon claimed that there was no jugular vein injury during the surgery and that the jugular vein injury found at autopsy occurred during the code response. The defendant physician also claimed that the death was related to a blood clot, which had dislodged when the child was coughing. The blood clot then traveled to his lungs causing the death. Initially, a jury found in favor of the physician in 2007, but the case was appealed. A second trial was held in 2011. This ended with a hung jury, and a mistrial was declared. The matter was tried for a third time (12 years after the incident) resulting in a verdict that favored the physician. The defendant surgeon apparently used different pulmonary medicine and otolaryngology experts for the third trial. Lafayette County, Mississippi Circuit Court, Case No. 02Y186.
EDITOR’S COMMENTS Postoperative bleeding after tonsillectomy and adenoidectomy is always a worrisome chief complaint. This is a
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Volume 29, Number 12, December 2013
tragic case, and it seems that it was very difficult to truly determine what caused the patient’s death.
A
4-month-old infant was transported to a New York ED in August 1995.6 The mother reported that the infant had stopped breathing while sleeping. A physician evaluated the boy and reached the opinion that the child had choked. He was discharged from the ED. In October 1995, the infant was brought back to the hospital, and the mother reported another episode of apnea during sleep. A physician evaluated him and believed that the incident was a ‘‘benign episode of deep respiration.’’ Later in October 1995, the infant was again brought back to the hospital because of another episode of apnea during sleep. At this time, it was determined that the event had caused hypoxic brain damage. The child survived with spastic quadriplegia. He requires a wheelchair, and will need lifelong care. The patient and his family sued the ED and claimed that the hypoxic event was actually sleep apnea that should have been diagnosed at the first examination. They maintained that the infant should have been provided treatment at the previous ED visits, which would have prevented the hypoxic event. The defendant physicians and hospital claimed that the symptoms reported by the mother did not suggest sleep apnea and that the infant did not experience this condition. A $7 million settlement was reached. Bronx County, New York Supreme Court, Index No. 15088/96.
EDITOR’S COMMENTS Without all the details, one cannot be critical of the management of this case. However, benign episode of ‘‘deep respiration’’ is a bold diagnosis when a baby presents with apnea. It is surprising that the baby was not admitted for diagnostic studies with the recurrent complaint of apnea.
A
20-year-old woman, who was 25 weeks pregnant, presented to a California ED in November 2008 for dysuria.7 Allegedly, she also complained of abdominal pain and back pain, but this was denied by the physician who treated her. A urinalysis was performed, and the patient was diagnosed with a urinary tract infection. She was prescribed with cephalexin and instructed to follow-up with her primary care physician. The next morning, the patient went to the labor and delivery unit of a hospital, where she was determined to be in labor and already 8 cm dilated. An emergency cesarean delivery was performed. The baby weighed * 2013 Lippincott Williams & Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Pediatric Emergency Care
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Volume 29, Number 12, December 2013
1.75 lb at birth and had severe respiratory complications. The infant was diagnosed with a patent ductus arteriosus and developed intraventricular hemorrhage 5 days after birth. The infant also experienced hypoxic ischemic encephalopathy, causing severe brain damage. She has received treatment at a chronic care facility. The baby’s mother sued the emergency physician and the group who employed her and alleged that the doctor failed to diagnose preterm labor. She claimed that an obstetrician should have been consulted, and had she been transferred to a labor and delivery unit, she would have received treatment to stop her labor. The defendant emergency physician claimed that the mother had only complained of pain during urination and that she gave conflicting accounts when she returned to the hospital the next morning. Allegedly, she told a nurse that her back pain began after her initial discharge from the ED and told other personnel that she had complained of back and abdominal pain during her initial visit. The doctor also claimed that the mother’s preterm labor was not related to the urinary tract infection but was due to the patient having a shortened cervix. A jury found in favor of the ED physician. Los Angeles County, California Superior Court, Case No. MC021601.
* 2013 Lippincott Williams & Wilkins
EDITOR’S COMMENTS It is not clear if earlier diagnosis would have changed the outcome in this case. It is assumed that the emergency physician asked about pain (abdominal and back), and it is likely that the physician was able to defend the case because of proper documentation.
A
woman from Tennessee experienced difficulty breathing in October 2007 and called 911.8 An ambulance arrived, and the patient was transported to a nearby hospital. During transport, 2 straps on the gurney were secured, but a third strap was not. The ambulance driver made a sharp turn during transport. The patient was jostled on the journey, and her leg was bumped causing it to bleed. Because the patient was diabetic, the leg wound was slow to heal. Her leg was later amputated below the knee. The woman died 2 years later. The family sued the ambulance company and alleged that she had diminished enjoyment of life after the ambulance incident. They alleged negligence in failing to properly secure the patient. The defendant ambulance company denied any negligence. A judge found the ambulance company negligent, and the court awarded the family $232,091. An appeal was pending.
Legal Briefs
Monroe County, Tennessee Circuit Court, Case No. 08Y336.
EDITOR’S COMMENTS This is a terrible outcome and an almost unbelievable scenario. Things just continued to get worse after what seemed like a very minor omission. It is hard to believe something so minor could lead to consequences so major.
REFERENCES 1. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:3. 2. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:11Y12. 3. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:12. 4. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:15. 5. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:26. 6. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:6. 7. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:12. 8. Laska LL. Medical Malpractice Verdicts, Settlements and Experts. 2013;29:11.
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Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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