Delay in spotting compartment syndrome has permanent consequences
SEVERE NUMBNESS, TINGLING, AND PAIN IN HER LEFT CALF brought a 20-year-old woman to the ED. She couldn’t lift her left foot or bear weight on her left foot or leg. She reported awakening with the symptoms after a New Year’s Eve party the previous evening. After an examination, but no tests, she was discharged with a diagnosis of “floppy foot syndrome” and a prescription for a non-narcotic pain medication.
The young woman went to another ED the next day, complaining of continued pain and swelling in her left calf. She was admitted to the hospital for an orthopedic consultation, which resulted in a diagnosis of compartment syndrome. By that time, the patient had gone into renal failure from rhabdomyolysis caused by tissue breakdown. She underwent a fasciotomy, after which she required hemodialysis (until her kidney function returned) and rehabilitation. Damage to the nerves of her left calf and leg left her with permanent foot drop.
PLAINTIFF’S CLAIM The hospital was negligent in failing to diagnose compartment syndrome when the woman went to the ED. Proper diagnosis and treatment at that time would have prevented the nerve damage and foot drop.
THE DEFENSE No information about the defense is available.
VERDICT $750,000 Maryland settlement.
COMMENT Compartment syndrome can be challenging to recognize. Recently I have come across several allegations of malpractice for untimely diagnosis. Remember this important problem when faced with a patient with leg pain.
Multiple errors end in death from pneumonia
A 24-YEAR-OLD MAN WITH CHEST PAIN AND A COUGH went to his physician, who diagnosed chest wall pain and prescribed a narcotic pain reliever. The young man returned the next day complaining of increased chest pain. He said he’d been spitting up blood-stained sputum. He was perspiring and vomited in the doctor’s waiting room. The doctor diagnosed an upper respiratory infection and prescribed a cough syrup containing more narcotics.
Later that day the patient had a radiograph at a hospital. It revealed pneumonia. Shortly afterward, the hospital confirmed by fax with the doctor’s office that the doctor had received the results. The doctor didn’t read the radiograph results for 2 days.
After the doctor read the radiograph report, his office tried to contact the patient but misdialed his phone number, then made no further attempts at contact. The patient’s former wife found him at home unresponsive. He was admitted to the ED, where he died of pneumonia shortly thereafter.
PLAINTIFF’S CLAIM No information about the plaintiff’s claim is available.
THE DEFENSE No information about the defense is available.
VERDICT $1.85 million net verdict in Virginia.
COMMENT A cascade of mistakes (sometimes referred to as the Swiss cheese effect) occurs, and a preventable death results. Are you at risk for such an event? What fail-safe measures do you have in place in your practice?