No tests ordered, despite baby’s yellowing skin
Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited.
A 5-DAY-OLD INFANT’S YELLOW COMPLEXION led his worried mother to take him to a family practice. The physician assistant (PA) who examined the child noted yellowing of his face and chest. When the baby’s doctor arrived at the office unexpectedly, the PA consulted with her. The mother was given standard infant care instructions; no orders for diagnostic testing were issued.
Two days later the baby’s skin became yellower and he appeared lethargic. His mother brought him to a clinic, where she was told to take him to the hospital immediately. Testing at the hospital revealed an elevated bilirubin level. The infant developed kernicterus and suffered brain damage, resulting in developmental delays and cerebral palsy.
PLAINTIFF’S CLAIM The physician was negligent in failing to test and treat the infant promptly. The mother claimed that the physician had treated her older son for jaundice, as well. The mother also claimed that the physician noted the infant’s skin color but did nothing.
THE DEFENSE The infant’s sclera were white and he was alert and active when examined. The mother didn’t follow the instructions given to her.
VERDICT $6.25 million Delaware verdict.
COMMENT Many studies suggest that our ability to judge bilirubin levels on the basis of skin color is rather limited. It’s hard to imagine not doing a simple test in this situation.
Amputation blamed on tardy Dx of compartment syndrome
PAIN IN HER RIGHT LEG AND KNEE prompted a woman in her 60s to go to the emergency department (ED). She couldn’t remember any specific event or trauma that might have triggered the pain. Her history included deep vein thrombosis, pulmonary embolism, diabetes, hypertension, placement of a Green-field filter, and right knee replacement. She was taking warfarin; her international normalized ratio (INR) in the ED was 5.0. A physician diagnosed joint effusion and sent the patient home on pain killers.
Two days later, the patient returned to the ED complaining of numbness in her leg and excruciating pain in her right calf. She was seen by a different physician, who ordered a surgical consultation. Evaluation revealed a lack of sensation in her right foot, a dorsalis pedis pulse undetectable by Doppler ultrasound, and inability to dorsiflex or plantarflex the right foot.
Compartment syndrome was diagnosed and an emergent fasciotomy performed. The patient suffered extensive muscle and tissue death and became septic, necessitating an above-knee amputation. While recuperating and waiting for a prosthesis, the patient fell from her wheelchair, fracturing her dominant arm and shoulder in several places.
PLAINTIFF’S CLAIM No information about the plaintiff‘s claim is available.
THE DEFENSE No information about the defense is available.
VERDICT $890,000 Virginia settlement.
COMMENT When the diagnosis is ambiguous, close follow-up and reevaluation is key to avoiding a hefty settlement.