Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Melanoma Missed in Nail Bed Lesion
A man, age 51, visited his family practitioner with a raw spot in the nail bed of his right middle finger that would not heal. He was referred to a hand surgeon, who treated the lesion and sent a tissue sample to pathology in February 2004. The pathologist noted an abnormality, but testing for carcinoma was negative.
Over the succeeding eight months, the lesion did not heal, and antibiotics were prescribed. Swelling consistent with an infection developed in the patient's elbow and armpit. When a second biopsy of the finger and elbow was performed in October, a diagnosis of melanoma was made. By that time, the cancer had metastasized to the man's lungs, brain, and other organs. The original tissue samples taken in February were reexamined, and melanoma was found. The patient died in January 2005.
The defendants claimed that a reasonable work-up of the specimen had been done. They also argued that the cancer must have been so well developed in February that an earlier diagnosis made at that time would not have changed the outcome.
According to a published account, a $1.5 million verdict was returned.
Cephalohematoma and Seizures Blamed on Vacuum Extractor Delivery
The plaintiff infant's mother, age 24, was admitted to the defendant hospital at 40 weeks, three days' gestation for scheduled induction of labor. Labor progressed normally, with some nonreassuring fetal heart tones for part of the time. When the mother was completely dilated, she was told to start pushing.
Nonreassuring fetal heart tones occurred for a few minutes when the infant's head was crowning. The defendant attending Ob-Gyn decided to use a vacuum extractor and allowed his first-year resident to perform the procedure while he supervised. The delivery notes indicated that only one pull was required for the baby to be delivered.
The newborn weighed 8 lb 15 oz. In the nursery records, no perinatal asphyxia was noted, but molding of the head was noted. The baby's 25-hour hospital stay was uneventful, with no abnormalities seen.
Three days after the birth, a visiting nurse was sent by the hospital to check on the mother and the baby at home. She found that the baby was not feeding well and was jaundiced. The mother was advised to take the child to the hospital, where he was found to have a cephalohematoma.
The baby later suffered seizures and was taken to another hospital, where cephalohematoma and bleeding deep inside the brain were found. Vacuum delivery was a suspected cause, but abuse and/or neglect were also possible. X-rays were normal, and blood study results ruled out any bleeding disorder. The infant later developed mild cerebral palsy and continued to experience a seizure disorder. He also had mild behavioral problems and learning deficits.
The plaintiff claimed that a cesarean delivery should have been performed to avoid a traumatic delivery after nonreassuring fetal heart tones. The plaintiff claimed that the vacuum delivery was performed incorrectly and that the resident should not have been allowed to perform it. The plaintiff claimed that the vacuum was placed on the wrong part of the infant's head, that excessive force was used, and that the head was pulled to one side, making delivery more difficult.
The defendants contended that a cesarean delivery was not necessary, based on reassuring fetal heart monitor strips and the infant's normal neonatal course during his hospital stay. The defendants further argued against evidence of trauma, since the vacuum extractor succeeded with just one pull and was attached for only one to two minutes. The defendants suggested that the injury could have occurred after the child left the hospital. The defendants also maintained that the child was doing well and that his seizures could be corrected with surgery.
According to a published account, a settlement of $1,125,000 was reached. This included $200,000 from the Ob-Gyn's insurer and the remainder from the hospital.
One of Two MRI Orders Never Processed
In early October 2005, a 52-year-old woman began to experience back pain and weakness in her legs. Two months earlier, she had had back pain that was attributed to an injury at the gym. Results on plain x-rays of the spine that were ordered by her family physician in October were negative.
Two days later, her symptoms became much worse. She experienced extreme weakness and numbness in one leg and began to have bowel and bladder difficulty. Her family physician admitted her to the hospital and ordered an MRI of the lumbar spine to rule out a tumor. He also requested a neurology consult. The neurologist examined the patient and formulated a differential diagnosis of either transverse myelitis or a tumor in the T10 area. The neurologist ordered a thoracolumbar MRI to rule out spinal cord compression.