Real Stories of Medical Errors
The medical studies show that there are many millions of medical errors each year in the United States. Cold statistics, however, cannot fully convey the anguish that the innocent patients and their families suffer from these medical errors. So here are a few examples of real cases, to put those cold statistics in perspective. (Though the cases are real, the names are fictitious. No guarantee of any result can be made in your case. The outcome in each case is dependent on its unique facts.)
The Doctor Who Didn’t Know What She Didn’t Know
Janet G was an attractive and vivacious 23-year-old woman who loved kids and was working on her master’s degree in child psychology. Her family was from the East Coast, where her father was an Episcopalian priest and her mother a homemaker, but Janet had moved out West to attend graduate school, working on a master’s degree in psychology with a concentration in child psychology. There, she met and fell in love with Jimmy H, and the two of them planned to get married when Janet graduated.
It was a Saturday when Janet first came down with what she thought was either allergies or the flu. She had a runny nose and felt achy. By Sunday, a headache had started and she felt worse. She called her family practice doctor’s office, and the message service said that it would have the doctor call her back. Janet’s doctor (Dr. F) called her back and told Janet to come into the office first thing Monday morning. Janet followed her doctor’s instructions. In the doctor’s office Monday morning, Dr. F examined Janet and told her the she might have meningitis and told Janet that she would do a lumbar puncture to confirm the diagnosis.
A lumbar puncture (or spinal tap) is where the doctor inserts a needle into the spinal canal at the base of the spine to draw out some cerebrospinal fluid (also called CSF or spinal fluid). The spinal fluid is a clear, colorless liquid that slowly circulates around, and bathes, the brain and spinal cord. It helps protect the brain and serves various other functions. Spinal fluid pressure can be measured during the spinal tap. If the fluid pressure is high, it can help confirm a diagnosis of meningitis. Also, the fluid can be analyzed to see if there are bacteria in it.
When Dr. F did the spinal tap on Janet, Janet’s spinal fluid pressure was markedly high, so high that she was in danger of having a brainstem herniation if Dr. F withdrew the spinal tap needle. (A brainstem herniation is where high intracranial pressure (pressure inside the skull) forces the base or stem of the brain through the hole at the bottom of the skull where the spinal cord exits the skull. It can kill a patient. If it doesn’t kill the patient, it nonetheless can kill nerves in the brain stem.) With markedly high pressure readings like Janet had, the physician should leave the needle in place while attempts are made to bring intracranial pressure down, when it would be less risky to remove the needle.
But Dr. F had no clue of the risk to Janet, and so Dr. F withdrew the needle. Fortunately, Janet did not herniate her brainstem at that time, and so Dr. F’s negligence at that point caused no injury (that would come later).
Dr. F then correctly decided to admit Janet to the local hospital. However, Dr. F did not have admitting privileges, and so Janet was admitted to the care of Dr. I, who was an internist who had admitting privileges at the hospital and who was also a friend of Dr. F. As was required by the hospital’s policies, Dr. I did the admitting history and physical examination of Janet, but because he planned on having Dr. F help care for Janet in the hospital and he knew that Dr. F had already examined Janet, Dr. I did a fairly cursory job on the admission history and physical. He did not see that Janet had a markedly elevated spinal pressure reading. He later admitted at deposition that had he seen it, he would immediately have started Janet on Decadron, which is a corticosteroid that helps to reduce brain swelling and elevated intracranial pressure caused by infections like meningitis, which in turn reduces the risk of a brainstem herniation.
Instead of being admitted to the ICU as she should have been and where she would have been monitored frequently by RNs, Janet was admitted to the general hospital floor, where she was monitored less frequently by LVNs (licensed vocational nurses), who have less training and generally less experience in serious illnesses than RNs. Janet was admitted at about 10:00 a.m. Throughout the day, her condition deteriorated. By about 4:00 p.m., Janet began getting agitated, pulling at her IVs and pulling out her urinary catheter. The LVNs failed to recognize the seriousness of Janet’s deteriorating condition and so did not sound any alarms to Dr. F (who sporadically checked in by phone on how Janet was doing). Janet still was not given any diuretics or corticosteroids, which would have greatly lowered the risk of a brainstem herniation. Jimmy (who had returned to work that day after Janet was admitted) telephoned for Janet and was told by the nurses that Janet was doing well but was sleeping, and they didn’t want to disturb her.
Janet’s condition continued to deteriorate. She began drifting in and out of consciousness. Still, the seriousness of the situation was not recognized by the hospital staff. At about 1:00 a.m., Janet “blew a pupil.” This means that one of her pupils became fixed and dilated. A blown pupil can suggest several different things, but in Janet’s case it was most suggestive of dramatically increased intracranial pressure and the beginnings of a brainstem herniation. At this point, the LVNs recognized that something serious was going on and notified Dr. I, who was at home. Dr. I immediately drove to the hospital, but it took him about 22 minutes. When he arrived and examined Janet, he realized that her brainstem was herniating, and he promptly gave Janet the corticosteroid Decadron as well as diuretics. This medication worked, and after a short while Janet’s pupil was back to normal (meaning that the brainstem herniation had receded).
But by then, the damage was done. Janet had experienced a brainstem herniation that killed the nerve cells at a very high level in her spinal cord. As a result, she was permanently totally paralyzed from the neck down. She could only feel the oval of her face and could only move those face muscles. All of this could have been avoided if the doctors had recognized upon admission that Janet needed to be followed in the ICU and needed corticosteroids and diuretics, which we know would have prevented the brainstem herniation, since they in fact had worked to reverse the herniation once it had started. The tragedy would also have been avoided if the nurses had recognized the seriousness of the situation when Janet’s condition first started deteriorating significantly, instead of delaying over 9 hours before realizing the danger and alerting the doctor.
Janet’s life as a healthy, vibrant adult was destroyed. Janet’s family, her fiancé Jimmy, and Janet’s friends all were devastated. Instead of moving Janet back to the East Coast, Janet’s parents moved from the East Coast to help care for Janet, because Janet had lost her ability to thermoregulate (that is, maintain a normal body temperature) and the area where Janet had been going to school was a better environment for her in that regard. Janet retained most of her intellectual capabilities, so she was fully aware that her body had now become a prison. She needed care 24/7. She could not move, breathe, or eat on her own. She had to communicate by looking at letters on a board that her family would hold up for her, with her family tracking the letters that she was looking at and then spelling out the words. She had no ability to summon her family if she wanted to be moved to another room or simply needed someone to scratch her nose (basically the only area on her body where she could feel anything). Her loving fiancé Jimmy stayed with her and visited daily. Her brothers and sisters (who lived on the East Coast) visited when they could. Because the family was not wealthy, they themselves performed most of the care services that Janet required, with help from local church members (where the father had secured part-time employment).
We handled Janet’s case. The doctors and hospital fought vigorously, arguing (incredibly) that they were not negligent and even if they were, Janet would have been seriously injured in any event. After a long, hard-fought battle, the defendants finally agreed to settle the case and pay Janet a compensation package worth over $30 million if she lived out a normal life expectancy, $3.175 million of which was received up front and the balance of which was in monthly installments for Janet’s life, which monthly payments were guaranteed to her family for a minimum of 10 years no matter when she died (total package present value of $5.65 million). (Please note that no guarantee of any result can be made in your case. The outcome in each case is dependent on its unique facts.) With that money, the family was able to hire professionals to help care for Janet. They were able to move to Florida, where the weather was optimal for Janet’s inability to thermoregulate and where one of Janet’s brothers lived. Janet purchased a house that the family was able to outfit for Janet’s special needs. Janet was able to buy special eye-tracking equipment that increased her ability to communicate. She was also able to buy a “sip-and-puff” electric wheelchair that allowed her to use her mouth to guide her wheelchair around the house. For the first time, she had some degree of independence.
Dr. I should have performed a thorough history and physical on Janet. If he had, he would have seen that Janet had a dangerously elevated spinal fluid pressure, and he would have admitted her to the ICU and administered the appropriate medications that would have prevented the brainstem herniation. Dr. F should never have attempted to follow Janet in the hospital with Janet’s markedly high spinal pressure reading. It was above Dr. F’s skill set. But Dr. F didn’t know what she didn’t know, and Janet paid for it for the rest of her life.
What’s a Late Deceleration?
Shanda D was 22 when she became pregnant with her first child. She and her husband Joe were ecstatic. Shanda bought and read all the pregnancy books and baby books that she could get her hands on. She ate well and exercised moderately, like the books recommended. All of her prenatal visits with her obstetrician went swimmingly. Then, the big day came, and Shanda went to the local hospital to give birth. At the hospital, Shanda was hooked up to an electronic fetal monitor, per the Labor & Delivery (“L&D”) Department’s protocol.
An electronic fetal monitor (“EFM”) is a machine that monitors the baby. Among other things, it tells the healthcare team what the baby’s heart rate is, what the “beat-to-beat” variability is, and how the baby’s heart rate responds to the mother’s contractions. (The mother’s contractions put stress on the baby, and how the baby’s heart rate responds can give the healthcare providers valuable information.) The EFM prints out a strip of paper (called the EFM strip) that visually shows how the baby’s heart rate responds to the mother’s contractions. Certain patterns on the EFM strip are reassuring that all is going well. Other patterns are warning signs that potentially the baby may not be getting enough oxygen for various reasons. These are called non-reassuring patterns. These warning signs require closer observation of the mother and baby. Still other patterns are ominous signs that the baby is not receiving enough oxygen and is at risk of brain damage. These ominous patterns require immediate delivery by Caesarian section if they are not alleviated by certain medical interventions designed to get more oxygen to the baby. (In 2009, the American College of Obstetrics and Gynecology adopted a new nomenclature of “Category I,” which is normal, “Category II,” which is indeterminate and may require heightened surveillance and reevaluation, and “Category III,” which is abnormal and predictive of abnormal fetal-acid base status. Category III requires certain efforts to expeditiously resolve the underlying cause of the abnormal fetal heart rate pattern. If these efforts are unsuccessful in remedying the problem, emergency Caesarian should be performed. We use the older nomenclature (of reassuring, non-reassuring, and ominous) rather than the newer nomenclature, since the older nomenclature is more descriptive.)
At most hospitals, the obstetrician visits the laboring mother only intermittently, until the baby is ready to be born. It is the L&D nurses who are primarily responsible for monitoring the mother. However, at most hospitals and with an uncomplicated labor, it is unusual for an L&D nurse to be present with the mother at all times. Usually, each L&D nurse is taking care of two expectant mothers simultaneously and sometimes more.
Obviously, it is critical that the L&D nurses be able to accurately assess the condition of the mother and the baby during the labor process. As noted above, labor is stressful on the baby. Each contraction of the mother acts to (temporarily) decrease the flow of blood and oxygen to the baby. As the labor process wears on, the baby’s fetal reserves may decrease. (The phrase fetal reserves is shorthand for the baby’s reserves of oxygen and its ability to withstand stress, including low oxygen levels, without sustaining permanent injury.) The EFM pattern can suggest when the baby’s oxygen reserves are sufficiently depleted that the baby is at risk of sustaining brain damage from low blood oxygen levels. Usually, an ominous EFM pattern does not just suddenly appear. Usually, the pattern will first change from reassuring to non-reassuring, which means that things need to be watched more closely. A non-reassuring pattern may revert to a reassuring pattern, either on its own or with certain interventions. However, at times, a non-reassuring pattern may progress to an ominous pattern, which suggests that the baby is at very high risk of sustaining multi-organ damage (including brain injury) or death unless delivered quickly (usually by emergency Caesarian section).
One ominous EFM pattern is absent or minimal beat-to-beat variability combined with recurrent late decelerations. (Beat-to-beat variability is the change in the baby’s heart rate from beat to beat. Late decelerations are decreases in the baby’s heart rate that start after the contraction has started and that come back up to baseline after the contraction is completed.) Absent or minimal beat-to-beat variability combined with recurrent late decelerations is highly suggestive that the baby is becoming hypoxemic (that is, there is not enough oxygen in the baby’s blood, which can cause multi-organ damage, including brain damage, or death). If an L&D nurse sees that pattern, then he or she should immediately notify the doctor and take certain actions to try to resolve the problem. If the problem does not quickly resolve, then immediate delivery is usually indicated. If minimal beat-to-beat variability with late decelerations progresses to include bradycardia (abnormally slow fetal heart rate), it is particularly ominous and a true medical emergency.
Shanda’s labor progressed normally at first. However, the EFM strip then began showing some late decelerations with decreased beat-to-beat variability. The L&D nurse caring for Shanda did not appreciate the significance of these changes in the EFM strip. As time went on, the late decelerations became more persistent and beat-to-beat variability further decreased, indicating fetal distress. Still, the L&D nurse sounded no alarms. Meconium-stained fluid was then noted (it had been clear earlier). (Meconium is the baby’s feces. Fetal distress can cause the baby to pass feces in the womb.) Still, the L&D nurse, who was simultaneously caring for 2 other laboring mothers, did nothing. Finally, the EFM strip showed bradycardia, which the L&D nurse first noted about 10 minutes after it started. The L&D nurse then placed a call to the obstetrician, who was not at the hospital. The obstetrician arrived fairly quickly, recognized the true medical emergency that was occurring, and order a STAT C-section (emergency C-section). However, even STAT C-sections take some time to accomplish, and so Christopher D wasn’t delivered until a bit over 30 minutes later. By that time, he had permanent cerebral palsy (a type of brain damage) due to fetal hypoxia (lack of oxygen to the brain). (This type of brain injury is called hypoxic-ischemic encephalopathy.) Christopher will never be able to walk or talk or care for himself. Despite his motor limitations, Christopher’s mind is still active.
Shanda came to us when Christopher was 8, and we took the case. (Unfortunately, the stress of caring for a child with severe CP had contributed to the breakup of Shanda and Joe’s marriage.) At her deposition, the L&D nurse had difficulty defining what a late deceleration was or what decreased beat-to-beat variability was. She was shown fetal monitor strips taken from obstetrical nursing textbooks and asked to identify the various patterns. She had difficulty doing so. Still, the defense argued that her care had been appropriate and that even if it was not, Christopher was destined to have CP in any event. After many months of hard work against a vigorous defense, we were able to secure a settlement package paying over $10 million should Christopher live a normal life span, some of which was received up front and some of which was in monthly installments for Christopher’s life, guaranteed to his family for a minimum of 25 years should he die before then (total package present value $1.6 million). With these funds, Shanda was able to purchase a house and outfit it for Christopher’s special needs. She purchased a van with a mechanical lift to help her get Christopher in and out of the van for doctors’ appointments, etc. (Christopher was starting to get heavy and Shanda was a petite woman – in a few more years, she would not have been able to lift him). Shanda and Christopher were able to afford the latest in medical treatment and equipment. Importantly, Shanda had the peace of mind of knowing that if something should happen to her, Christopher would be well provided for.
Mother (and Grandmother) Really Do Know Best
It was 4:00 a.m., and Teresa’s one-year-old baby boy Antonio wouldn’t stop crying. Teresa O was 24 years old and came from a large Hispanic family. She was the youngest child. Because Teresa was separated from her husband and therefore had to work to support herself and Antonio, Teresa and Antonio lived with Teresa’s mother Amalia P, who took care of Antonio during the workday.
Antonio wouldn’t stop crying. Teresa took Antonio’s temperature, and it was slightly elevated. Even though it was 4:00 a.m. and even though Antonio was running just a slight temperature, Teresa and Amalia instinctively knew that this was not a normal illness. They took Antonio to the emergency room, which happened to be at a tertiary hospital. A tertiary hospital is the top of the food chain for hospitals. It is a major hospital that has a full complement of services and specialists. Tertiary hospitals are where primary hospitals send their patients who need higher levels of care. Unknowingly, Teresa and Amalia had gone to precisely the right hospital for Antonio’s care.
However, in the emergency room, Antonio was not seen by a pediatric e.r. specialist (even though they were on staff at the hospital). Rather, he was seen by a garden-variety e.r. doctor, one who was unaware that certain signs, symptoms, and findings that might be benign in an adult or older pediatric patient, are warning signs in a one-year-old child such as Antonio. This failure would have devastating consequences for Antonio.
The e.r. staff examined Antonio and documented irritability, poor feeding, vomiting, a moderately elevated temperature, and a moderately elevated respiratory rate. They told Teresa and Amalia that Antonio had the flu and discharged him home around 5:30 a.m. The family went home, where Antonio continued to do poorly. Later that day at about 4:00 p.m., Teresa and Amalia took Antonio to the pediatrician because Antonio was not getting any better and, if anything, was getting worse. The pediatrician immediately recognized that Antonio might have bacterial meningitis and sent Antonio back to the hospital for assessment, where he was admitted and tests performed that confirmed the diagnosis of bacterial meningitis. However, by then it was too late, and Antonio suffered severe and irreversible brain damage. All of this was avoidable, had the e.r. doctor earlier that day simply walked about 5 feet to the phone on the wall and called for a pediatric e.r. consult. Had he done that, a pediatric e.r. specialist would have recognized that Antonio was at high risk of having bacterial meningitis and would have performed appropriate testing. Although there was only a 12-hour or so delay from the time that Antonio was initially seen early that morning until he finally was correctly diagnosed and started receiving antibiotics and other medications late that afternoon, bacterial meningitis can advance quickly, and those 12 hours were crucial in terms of the degree of brain injury that Antonio suffered. It made the difference between a kid who might have had some minor neurological impairments versus one who was sentenced to live in a vegetative state for the rest of his life.
We handled Antonio and Teresa’s case. As usual, the defense fought hard, but in the end, we were able to secure settlement for them in excess of $1 million. Rather than listen to the concerns of Antonio’s mother or his grandmother (who was a highly experienced mother herself, having had 7 kids), the emergency room physician minimized their concerns, and Antonio and his family paid for it.
Unaware of Danger
At age 68, Louise M had arrived at the golden years. She and her husband of 46 years were comfortably retired with 3 grown children and 4 grandchildren. Louise was known to have coronary artery disease, and her symptoms had progressed to a point where Louise’s cardiologist suggested that she have a coronary angiogram. A coronary angiogram is a relatively minor procedure done under local anesthesia where a small catheter is inserted into an artery in the groin and then is threaded up to the heart. There, a small amount of a radiographic contrast agent is injected and x-rays are taken. This allows the coronary arteries to be visualized to reveal the extent and severity of coronary artery blockages. When the x-rays are finished, the catheter is then withdrawn and the artery is sutured, sealed, or treated with manual compression to prevent bleeding.
Louise’s angiogram was done in the morning at the hospital. However, in performing the procedure, the physician inadvertently made a small puncture wound in the backside of the artery, which caused Louise to bleed into her retroperitoneal space. (The retroperitoneal space is the space behind the peritoneum, which is the membrane that forms the lining of the abdominal cavity. The abdominal organs are contained within the retroperitoneal space.) In other words, Louise had internal bleeding. Over the next 12 hours, Louise’s condition deteriorated. Among other things, her blood pressure began to drop from her loss of blood (the blood was still in her body, but it was out of the blood vessels and in the retroperitoneal space). To compensate for her lower circulating blood volume, her pulse and respiratory rate began to rise. For too long, the nurses at first did not appreciate the seriousness of the situation. However, when Louise’s fingernail beds and lips started showing signs of cyanosis (a bluish or purplish tinge, indicating low oxygen levels), they finally began attempting to reach the surgeon, who by then had left the hospital and gone to dinner (and who would later testify that he had a number of drinks at dinner). Rather than summon one of the other staff physicians who were then actually physically present at the hospital, the nurses continued to wait for the surgeon to respond. When the doctor finally did respond and drive to the hospital, it was too late. Louise had died of internal bleeding. Her death was completely avoidable. Had a doctor been summoned by the nurses to examine Louise the many hours earlier when she first started with the telltale signs of internal bleeding, the bleeding could have been detected and stopped. Louise did not have to die.
We handled Louise’s case for her husband and adult children and were able to secure a substantial recovery for them. The angiography showed that Louise’s coronary artery disease was not too far advanced and certainly was amenable to treatment. With appropriate treatment, she had many more years of life expectancy left. But the nurses were unaware of danger and so failed to sound any alarms until it was too late, and it cost Louise and her husband, children, grandchildren, and friends the joy of those remaining golden years.
Betty T was a mother of two and grandmother of four, as well as a loving wife to her husband, Oscar. At age 67, she was still working at the job she loved, providing in-home care services to elderly disabled people. Her adult son Walter, his wife, and their two children lived with Betty and her husband. One morning, Betty awakened with a severe headache. She hardly ever had headaches, and this one was more severe than anything that she had ever experienced. She couldn’t work, and so she took an Advil and laid down to rest. About noon, Walter fixed her something to eat. She tried to eat but was nauseous and couldn’t eat. The severe headache continued. At about 5:30 p.m., Walter took Betty to the after-hours clinic of her HMO. There, she saw Dr. Z, a family practice physician. Dr. Z took a cursory history and physical, noting Betty’s history of high blood pressure but recording that it was not overly elevated on the day in question. He did not inquire into details of the headache (e.g., whether it was constant, pulsatile, sharp, made worse by changes in position or by bearing down, etc.), nor did he elicit whether there was any family history of headache. The doctor performed a cursory neurologic exam, failing to test Betty’s gait and coordination, incompletely testing her for signs of meningeal irritation, and incompletely testing her motor strength and sensation. Dr. Z then diagnosed a new-onset migraine headache (even though a new-onset migraine headache in the elderly is relatively rare) and discharged Betty home with some pain medications. Upon arrival home, Betty went straight to bed in Walter and his wife’s bedroom downstairs, fully clothed, as she couldn’t make it up the stairs to her and Oscar’s bedroom. About midnight, she asked Walter to help her to the bathroom, but as soon as she stood up, she collapsed to the floor. Walter helped her back into bed. At about 2:00 a.m., she was snoring, something that she did not usually do. Oscar (the husband) went to work at 6:00, being quiet so as not to disturb Betty. When Walter and his wife awakened about 6:30, they discovered that Betty was dead.
Autopsy revealed that Betty had died of an intracerebral hemorrhage, specifically, bleeding in the basal ganglia (a part of the brain). She undoubtedly had started bleeding that morning when she had awakened with a severe headache. The HMO’s own clinical practice guidelines state that the warning signs of intracerebral hemorrhage include age greater than 60 and new-onset headache in the elderly, and they also state that it is unusual for migraines to first start in an elderly person. But, Dr. Z was unfamiliar with those practice guidelines. Dr. Z should have sent Betty and Walter to the emergency room for an emergent CT scan of Betty’s head. Had that happened, the brain bleeding likely would have been seen and Betty would have been admitted to a neurointensive care unit, where she would have received appropriate treatment that probably would have saved her life.
We represented Betty’s family and were able to obtain a substantial recovery for them. During the discovery phase of the lawsuit, it came out that at the very time that Dr. Z treated Betty, he was being investigated by the state medical licensing board for having had sex with multiple of his married patients, which led to charges being filed against him by the state medical board. Needless to say, Dr. Z was probably a bit preoccupied at the time that he saw Betty. She paid for it with her life.
Brief Descriptions of Other Cases
Below are brief descriptions of additional real cases. (Although the cases are real, the names are fictitious. No guarantee of any result can be made in your case. The outcome in each case is dependent on its unique facts.)
Misfiling of EKG report leads to heart attack and death of 40-year-old man: A forty-year-old husband and father of two had a general physical exam at his HMO. Part of the physical was a routine EKG. The EKG was not read by the family doctor but rather was sent to the HMO’s cardiac lab to be read. That process took a week or so. The cardiologist at the lab correctly read the EKG as abnormal and one that required that the patient see a cardiologist. The EKG results were then routed back to the family doctor, but for some unknown reason, they were simply placed in the patient’s medical chart without the family doctor being made aware of the results or the recommendation that the patient follow up with a cardiologist. Four months later while running, the patient dropped dead of a heart attack. Because of his youthful age and excellent health, an autopsy was done. The autopsy showed that the patient had what is called “single vessel disease.” In other words, only one of his three major coronary arteries was diseased. Had the patient been referred to a cardiologist, his single vessel disease would have been detected and appropriately treated. The patient, who was a amateur marathon runner, would have been a perfect candidate for stenting or by-pass surgery, which would have prevented the heart attack.
Holding child face down while lancing a boil results in suffocation and permanent brain injury: A four-year-old boy had fallen and scraped the back of his neck while playing outside. Over the next few days, it turned into a boil. Rather than attempt to lance the boil at home, the mother (responsibly) took her son to the local emergency room, which happened to be at a teaching hospital. There, a medical student and two residents held the boy face down on a gurney while another resident infiltrated lidocaine and lanced the boil. The child had a cardiac arrest. By the time that he was successfully resuscitated, he had suffered permanent brain damage from lack of oxygen. At deposition, the attending physician (a senior physician who supervises the residents and medical students) admitted that investigation showed that the boy had suffocated when the medical student held him face down on the gurney.
Misreading of mammogram results in delayed diagnosis of cancer: Warning signs of cancer were missed in a mammogram of 42-year-old female. The cancer was later detected, but because of the delay, the patient suffered from a more advanced disease. More extensive and invasive medical treatment was required, and she suffered loss of chance of cure and a diminished life expectancy.
Failure to appreciate pattern on EKG results in missed diagnosis of heart attack and death: A 64-year-old married man awakened at about 3:30 a.m. with pain in his chest. He took some antacids and tried to go back to sleep, but the pain did not decrease, and so at about 4:15 a.m., he and his wife drove to the local emergency room. The young emergency room physician initially wrote in the medical chart that the patient complained of dull, “crushing”-type pain in his chest with no radiation, but that entry was crossed out and above it the doctor wrote “sharp” pain with no radiation. The doctor looked at the EKG strip, recorded that it was normal, diagnosed heartburn, and discharged the patient home. A short while after driving home, the patient died of a myocardial infarction (heart attack). In reality, the EKG strip had an elevated ST wave segment not present on earlier EKGs, suggestive of (among other things) an ongoing heart attack and warranting further investigation, as well as fibrinolytic and other therapy. Had the medical emergency been timely recognized and treated, the patient likely would not have died.
Failure to diagnose pulmonary embolism causes death: A 67-year-old man presented to his family practice doctor complaining of right-sided chest, shoulder, and back pain. The patient denied shortness of breath but stated that he was very uncomfortable and unable to sleep and that it hurt to move around. The patient was mildly tachycardic (fast heart rate) and was borderline hypertensive (high blood pressure) and borderline tachypnic (fast breathing rate). An EKG was normal except for the tachycardia. Although the patient had several predisposing factors to pulmonary embolism, the doctor did not perform any further investigation. Rather, the doctor diagnosed back strain with radiation (even though there was no specific event to which a back strain could be attributed), prescribed an anti-inflammatory and pain killers, and discharged the patient home. The patient went into shock the next day and was taken to the emergency room, where an echocardiogram showed evidence of a large pulmonary embolism. The patient died in the e.r. Had the family practice physician performed further investigation the day before, the pulmonary embolus likely would have been discovered and appropriately treated and the patient’s death likely would have been avoided.
Failure to appreciate risks arising from large baby, coupled with poor delivery technique, results in brachial plexus injury: A mother with gestational diabetes had a fetus that was large for dates. The obstetrician failed to plan for a macrosomic (large) baby and potential cephalopelvic disproportion (where the baby is too large to safely fit through the mother’s pelvis). A shoulder dystocia resulted (that is, one of the baby’s shoulders got hung up on the mother’s pubic symphysis during birth, preventing delivery – this is an obstetrical emergency). The obstetrician used poor technique in attempting to free the shoulder, resulting in a left brachial plexus injury (Erb’s palsy) and permanent significant loss of use of the child’s left arm.
Failure to detect hydrocephalus results in permanent brain injury: A 15-month-old girl was taken by her mother to the pediatrician for a routine well-baby checkup. The physician documented that the girl’s head circumference was above the 98th percentile and her body weight was in the 96th percentile. Although on earlier well-baby visits the girl’s head circumference had been at the 97th percentile, this was the first visit where it was above the 98th percentile. The physician recorded a normal well-baby examination. The family then moved out of state for a little less than a year, during which time the child did not see a pediatrician. When the family moved back, the child again saw the original pediatrician for a well-baby visit. By that time, the child’s head circumference was far enough above the 98th percentile that the pediatrician ordered head imaging, which revealed hydrocephalus. (Hydrocephalus literally means “water on the brain.” It is a condition where there is an excessive buildup of cerebrospinal fluid in the brain, usually as a result of a blockage of the flow of cerebrospinal fluid.) A shunt was surgically placed to drain the excess fluid, but by then, the damage had been done and the girl suffered permanent brain injury. When the pediatrician was asked at deposition whether the head circumference reading at the 15-month checkup had caused him any alarm, he responded that it had not, because he simply thought that this was a “big child who had a big head.” What the pediatrician failed to realize is that when the child’s head circumference first crossed the 98th percentile line on the chart, it was an indication for head imaging and follow-up by a pediatric neurologist, regardless of what the girl’s weight was. The doctor also failed to assess the parents’ and siblings’ head circumferences. Macrocephaly (abnormally large heads) tend to run in families. Had the girl’s parents or siblings been macrocephalic, there may initially have been somewhat less cause for alarm. Our experts’ assessment of the parents and siblings showed that they were not macrocephalic, although the pediatrician never assessed that factor. Had the girl undergone neuroimaging when her head circumference first breached the 98th percentile, the hydrocephalus likely would have been detected and treated, and she would not have suffered permanent brain damage.
Inadequately supervised resident causes brain bleeding during labor and delivery process, resulting in permanent hemiplegia (one-sided partial paralysis): A 23-year-old first-time mother went to a local teaching hospital (where residents, who are new doctors, are trained) to give birth to her son. She was attended to by an obstetrical resident. As the labor progressed during the night, the progress of the labor was markedly slower than normal even for a first-time mother. This suggested (among other things) possible cephalopelvic disproportion (that is, that the baby’s head was too large to safely fit through the mother’s pelvis) or malposition (that is, that the baby’s head presented in a sub-optimal orientation). Rather than call the attending physician (a medical school faculty member who was responsible for supervising the resident), the resident augmented labor with Pitocin (a drug that strengthens the mother’s contractions). Finally, after a too-long period with no descent of the baby’s head, the resident called the attending physician, who arrived and ordered a STAT C-section, but by then it was too late. The repeated contractions of the mother (which were strengthened due to the Pitocin) had continually rammed the baby’s skull into the mother’s pelvic bones, resulting in a fracture of one of the baby’s skull plates, brain bleeding, and permanent partial hemiplegia (partial one-sided paralysis).
Failure to timely recognize and appropriately treat high bilirubin levels in newborn causes brain damage: A mother gave birth to a premature baby (31 weeks gestation). The baby encountered some problems in the neonatal intensive care unit (“NICU”), which were well-addressed, except for one – hyperbilirubinemia (high bilirubin levels, or jaundice). Failure to recognize and then treat the hyperbilirubinemia aggressively enough resulted in kernicterus (a bilirubin-induced type of permanent brain damage that causes choreoathetoid cerebral palsy, oculomotor impairment, impaired digestive function, and partial deafness).
There are many ways that medical errors happen. If you would like us to evaluate whether a healthcare provider may have made a medical error and caused substantial harm to you or a loved one, contact us and ask. You may contact us either by phone, by e-mail, or by filling out the brief confidential questionnaire on the left. It is free.
We handle cases throughout all of Washington.