Patient unaware of abnormal scans until it was too late ... For want of steroids, sight is lost ... more
The cases in this column are selected by the editors of The Journal of Family Practice from Medical Malpractice: Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (https://www.triplelpublications.com/product/medical-malpractice-newsletter/). The information about the cases presented here is sometimes incomplete; pertinent details of a given situation therefore may be unavailable. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation.
For want of steroids, sight is lost
A 78-YEAR-OLD MAN was diagnosed with polymyalgia rheumatica (painful inflammation of the arteries, usually in the shoulders and hips) by his longtime primary care physician. The doctor treated the condition with low-dose steroids and monitored the patient’s erythrocyte sedimentation rate and C-reactive protein.
Two years after diagnosis, the patient complained to the physician of jaw pain and transient vision loss in the left eye. Three days later, he called the doctor to say that he had developed a headache. The physician lowered the steroid dosage but didn’t order blood tests or a biopsy. The following day the patient woke up and discovered he’d gone blind.
PLAINTIFF’S CLAIM The patient had giant cell arteritis and should have been treated with high-dose steroids. Starting treatment even one day earlier would have prevented blindness.
THE DEFENSE No information about the defense is available.
VERDICT $3 million Washington settlement.
COMMENT Timely diagnosis and appropriate treatment of temporal arteritis remain essential.
Sudden chest pain, sudden death, but not the usual suspects
SUDDEN ONSET OF CHEST PAIN brought a 41-year-old woman to the ED. Results of an electrocardiogram, chest radiograph, and lab tests were all normal. While in the ED, the patient developed diarrhea and was diagnosed with a gastrointestinal bleed.
She was admitted to the hospital, but no bed was available, so she remained in the ED, where she was found dead 7 hours later. Autopsy revealed a type A dissecting aorta to the level of the renal arteries.
PLAINTIFF’S CLAIM The ED physician failed to rule out all potential life-threatening causes of the chest pain and didn’t order a CT scan, which would have showed the aortic dissection.
DOCTOR’S DEFENSE Aortic dissection is a rare condition; the patient didn’t fit the profile of an individual at risk. A chest radiograph almost always reveals such abnormalities; no duty existed to rule out aortic dissection.
VERDICT $1.4 million Ohio verdict.
COMMENT Even though the details of this case are sketchy—and any death is a tragedy—I can’t help but sympathize with the defendant. While as physicians we should not chase zebras, we still have to consider the possibility of rare conditions.
Misdiagnosed cold foot leads to amputation
NUMBNESS IN HER RIGHT FOOT prompted 2 visits to the emergency department by a woman in her early 40s. The foot was cold and discolored. By the second visit, the patient was screaming with pain. A sprain was diagnosed without consulting a vascular surgeon, and the patient was sent home.
Ten days later, the patient had a computed tomography scan at another hospital, which found a blockage of the popliteal artery. Her right leg was amputated below the knee the following day and she was fitted with a prosthesis.
PLAINTIFF’S CLAIM No information about the plaintiff’s claim is available.
THE DEFENSE No information about the defense is available.
VERDICT $1.25 million New Jersey settlement.
COMMENT I have seen a rash of cases in which peripheral vascular disease was inappropriately diagnosed. One wonders how an alert clinician could miss vascular disease and diagnose a sprain when faced with pain and a cold discolored foot.
