Suggestive symptoms, but no Dx until it was too late
A 42-YEAR-OLD WOMAN went to the hospital in February for chest pain, dizziness, and shortness of breath. The emergency room physician diagnosed sinusitis and bronchitis and discharged the patient in stable condition. In April, the woman visited her primary care physician complaining of fatigue and shortness of breath. She claimed that her physician knew about the February emergency room visit. Later in April, she again went to her physician with shortness of breath; in July, she reported an irregular heart rhythm.
In October, the patient was found unresponsive after suffering cardiorespiratory arrest, hypoxic ischemic brain injury, and static encephalopathy. She has since been in a vegetative state.
PLAINTIFF’S CLAIM The patient had gone to her primary care physician many times during the 2 years before her emergency room visit with complaints suggesting an underlying cardiac condition, including shortness of breath, dizziness, light-headedness, vertigo, chest tightness, fatigue, and an irregular heart rhythm. The defendants were negligent in failing to diagnose the patient’s condition and provide proper treatment, failing to order proper diagnostic testing, and failing to perform a cardiac workup.
THE DEFENSE No negligence occurred.
VERDICT $6.3 million Florida verdict.
COMMENT Comprehensive documentation, including your medical decision making, can help prevent multimillion dollar judgments.
A serendipitous finding—to no avail
A FALL ON THE ICE sent a 74-year-old woman to the hospital with a fractured ankle. A preoperative chest radiograph taken before open reduction and internal fixation to repair the fracture showed a 2-cm nodular opacity in the right upper hemithorax. The radiologist recommended a computed tomography scan to rule out lung cancer, but the treating internists didn’t order a scan or refer the patient for biopsy.
The nodule appeared again on a second radiograph taken 2 days later. The patient wasn’t informed, and the attending internist at the time didn’t order follow-up testing or refer the patient to a specialist. The attending physicians continued to treat the patient without further testing or referral for the nodule.
Two years after the fracture, the patient was admitted to the hospital with complaints of sweating and shortness of breath. A chest radiograph showed pneumonia and the previously noted nodule. The patient was diagnosed with metastatic, inoperable small-cell lung cancer. She died after receiving extensive chemotherapy and radiation.
PLAINTIFF’S CLAIM The doctors were negligent in failing to diagnose and treat the lung cancer in a timely manner.
THE DEFENSE No information about the defense is available.
VERDICT $325,000 Michigan settlement.
COMMENT Could this happen to you? How many times have you serendipitously noted an abnormal result that was not followed up adequately?