Case Examples as quoted by Attorney James I. Devine:
Diagnosis & Treatment Delay (settlement)
One interesting case I handled was a medical malpractice case in Philadelphia County involving a patient in his early sixties who had presented to the hospital for a pre-operative evaluation in anticipation of surgery for bladder cancer. According to the treating physician, the bladder cancer was treatable with the likelihood of cure with surgery. During pre-operative testing, a cardiac bypass surgery was recommended because of a discovery of blocked coronary arteries.
Following the cardiac bypass surgery, the patient was noted to have bilateral pneumothorax (a collection of air or gas in the space around the lungs). Chest tubes were inserted to address the pneumothorax. Shortly before the hospital discharge, the remaining chest tube was removed and the patient was discharged with a plan for home nursing. On the morning of the patient’s discharge, the patient’s body temperature was slightly elevated for the first time in several days. No consideration was given to the possible cause of this body temperature elevation and no investigation was made before discharge. On one of the home visits following discharge, the nurse documented the patient’s body temperature to be 101.8º. The cardiology physician was notified but did not order any tests or perform an evaluation. The physician did not consider the possibility of a post-operative infection. Within a few days, the patient developed low blood pressure and became extremely weak.
The patient was taken to the local hospital and later that day was transferred to the hospital where his heart surgery was performed. The patient was diagnosed with a massive sternal wound infection. Approximately two months later, after several surgeries, the patient died as a result of complications from the infection. I argued that there was an unreasonable delay in diagnosing and treating the infection, which resulted in an overwhelming and systemic infection directly leading to the patient’s death. The defendants argued that their care was reasonable and met appropriate standards. Both sides had experts supporting their positions. The case was ultimately settled amicably shortly before trial was scheduled to start for a significant amount.
Diagnosis & Treatment Delay (settlement)
Another interesting case I handled was a medical malpractice case in Philadelphia County involving a male teenage patient with a history of mild asthma who in the early winter suddenly developed several problems. His complaints included shortness of breath, lightheadedness, a fast heart beat and becoming easily fatigued. In early January, the patient presented to his pediatric physician with a complaint of passing out while playing lacrosse, along with the other complaints. A chest x-ray was ordered and it was recommended that he be seen by pulmonary physicians. The chest x-ray was reportedly normal. The patient was seen by pulmonary physicians who concluded that the chest pain was likely due to muscle strain.
In mid-January, because of persistent problems, the patient presented to his local hospital Emergency Room. He was seen by a cardiologist who ordered a chest x-ray and EKG. The cardiologist interpreted the x-ray as abnormal and recommended that a CT scan be ordered by the pediatrician. However, the pediatrician never ordered the CT scan, which, therefore, was never performed. The patient underwent several sets of pulmonary function studies through the spring, and the pulmonologist ultimately determined that his problems were due to vocal cord dysfunction from stress.
In the summer of that year, while attending camp as a counselor, the camp physician recommended an echocardiogram. As a result of the performance of the echocardiogram and follow-up studies, the patient was diagnosed with chronic pulmonary emboli, and pulmonary hypertension. On behalf of the patient, I argued that because of the delay in diagnosis and treatment of the patient’s condition, that medical treatment (i.e. medications) was not a viable option for the patient by the time the diagnosis was made. The patient required extensive lung and heart surgery and has experienced persistent elevated pulmonary hypertension ever since then, leading to a likely diminished life expectancy. Experts from various specialties supported the claims of the patient, and the defendants hired experts who supported their positions. The defendants argued that their care was reasonable and met appropriate standards. The case was ultimately settled amicably for a significant amount.
Anesthesia Negligence (settlement)
Another medical malpractice case I handled involved a female, teenage patient. By way of brief background, about four years earlier, the patient, then age 14, was a pedestrian who was hit by a car, and the patient sustained several injuries. One of the injuries the patient sustained was a right shoulder fracture and dislocation, resulting in nerve injury rendering the patient’s right arm and hand almost useless. A few years later, the patient’s orthopedic physician formed a plan to try to provide functional use of the patient’s right arm and hand, which involved surgery. Later that year, the patient presented to the hospital for right open shoulder release surgery. While the patient was still in the operating room, the anesthesiologist attempted an intrascalene anesthetic block injection to control the patient’s post-operative pain. The intrascalene muscles are located near the patient’s spine in the region of the neck. However, the injection was apparently placed directly into the spine. The patient was then transferred to another hospital because of breathing problems that developed as a consequence of the misplaced anesthetic block.
The patient developed progressively worsening problems in the weeks following the procedure and was referred to an Emergency Room where an MRI reported hydrocephalus (an accumulation of cerebrospinal fluid within the brain) and related abnormalities. Because of severe headaches and other disabling problems, the patient was unable to go to college as had been planned. She was also unable to work regular hours. Her right arm problems persisted because she was unable to follow through with the therapy and anticipated future surgeries. On behalf of the patient, I argued that because of the improperly placed anesthetic block the patient sustained injuries that will cause pain, suffering and disability for the rest of the patient’s life. The defendants argued that their care was reasonable and met appropriate standards. All of the parties had experts in support of their position. Shortly after the jury was selected, the case was settled amicably for a significant amount.
Brain Injury Due to Doctor/Hospital Negligence (settlement)
Another interesting case was a medical malpractice example involving a male patient in his early sixties with a prior history of a stroke who presented to the hospital in July with difficulty breathing. He was diagnosed with pneumonia. The patient was thereafter placed on a respirator because of declining oxygen saturation levels. Respirator ventilation required placement of an endotracheal tube orally through the mouth and vocal cords and into the patient’s trachea with the extruding end connected to the ventilation source. The tube was then replaced because it had developed a cuff leak. In mid-July, the patient underwent a thoracotomy surgical procedure with an evacuation of a fluid collection near one of his lungs. The next day, a nurse noted a leak in the endotracheal tube and notified the covering anesthesiologist about the problem. The anesthesiologist decided to reintubate the patient, but despite vigorous attempts, the doctor was unable to insert a new tube into the trachea, after removing the existing tube. The anesthesiologist then called aloud for the surgeon to be paged stat to perform an emergency tracheostomy. The surgical resident responded to the page. The resident had never before performed an unsupervised tracheostomy and did not have the necessary equipment because the hospital inexplicably did not have it available. The resident decided to perform a different procedure to try to establish an airway for the patient. Eventually, the surgical resident was able to establish a temporary airway.
The ENT surgical resident was then called to place the necessary trach tube. The ENT resident arrived but determined that he wanted an ENT attending physician to handle this difficult situation. Instead of waiting for an ENT attending physician to undertake the care of the patient, the anesthesiologist attempted to orally intubate the patient while the ENT resident slowly withdrew the trach tube placed by the surgical resident. The trach tube was completely withdrawn and the anesthesiologist was unable to insert the endotracheal tube. The patient’s airway was lost and he was not receiving oxygen. The ENT resident physician requested a scalpel to create another incision through the trachea to establish an airway for the patient, but no scalpel was available. The resident used a blade for the incision which caused the patient to lose several units of blood. The patient became pulseless and a code was called. The patient was resuscitated. The patient suffered significant brain injury and died two weeks later. On behalf of the patient, I argued that the patient died as a result of anoxic brain injury caused by the carelessness and conduct of the doctors and the hospital concerning the management of his airway and the unavailability of standard hospital equipment. The defendants argued that their care was reasonable and met appropriate standards. Both sides obtained supportive experts. Shortly before the scheduled start of trial, the case was settled amicably for a significant amount.
Premises Liability – Improper Ventilation (settlement)
The female, young-adult client presented to her place of employment in May. She was the store manager of a store in an indoor mall. She went to work early before opening the store for business. Her place of employment was adjacent to another business which was being remodeled. On that day, unbeknownst to the client, a contractor was using a propane powered concrete cutting saw to perform concrete cutting work. Propane powered concrete cutting saws emit carbon monoxide during operation. Carbon monoxide is a poisonous gas that is odorless, yet quite harmful, even deadly when inhaled. The mall where the client’s place of employment was located prohibited these saws because of their health dangers. When used indoors, fans or other types of effective ventilation must be set up to prevent harming persons in the area. The client was unknowingly inhaling carbon monoxide as the concrete cutting proceeded. Mall employees instructed the concrete cutters to stop using the equipment, when the mall employees discovered the use of the saw, but the mall employees and the concrete cutters failed to take obvious, necessary steps to protect individuals in the area. No one warned the client of the known carbon monoxide danger or properly ventilated the fumes. Shortly after noon, after being overcome by carbon monoxide fumes, the client passed out, fell down, hitting her head, and suffered a concussion. Carbon monoxide levels were obtained in the client’s place of employment and extremely high readings were discovered. The client was given hyperbaric chamber treatment, where oxygen under high pressure is administered in an attempt to clear the carbon monoxide from the blood.
Following the incident, the client suffered from persistent headaches and nosebleeds. The client was also diagnosed as suffering from Post Traumatic Stress Disorder. On behalf of the client, I argued that the contractors operated the propane saw without the necessary ventilation and that the mall employees failed to properly warn the mall employees of the known and failed to initiate ventilation. The defendants argued that their conduct was reasonable and met appropriate standards. Both sides obtained supportive experts. The case was ultimately settled amicably for a significant amount.