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Re: The strange case of Ms. S: can you guess the defense?

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  • Jurydoctor@aol.com
    In a message dated 1/10/2004 11:56:56 AM Eastern Standard Time, JuryDoctor ... [Non-text portions of this message have been removed]
    Message 1 of 2 , Jan 10, 2004
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      In a message dated 1/10/2004 11:56:56 AM Eastern Standard Time, JuryDoctor
      writes:

      >
      > Here is an interesting case. I am going to do something differently, this
      > time.. I would like to see if the defense is obvious in this case.. and
      > ofcourse, I would like your opinion on the case, please, given what you b elieve
      > the defense should be.
      > Have fun.. and as always thanks in advance for your thoughts.
      > Amy
      >
      >
      > Case of Ms. SM vs. M Hospital and several doctors and residents
      >
      >
      > On July 4, 1995 SM, a 37 year old woman, was awakened in the middle of the
      > night by a severe pounding headache. The headache was so severe that her
      > roommate took her to the emergency ward at M Hospital. At the hospital she was
      > seen by Dr. A, an emergency medicine doctor.
      > She reported to the nurse and doctor that she had a headache all over her
      > head with associated nausea and vomiting and slight photophobia (sensitivity to
      > light). He did a brief neurological exam, found no specific neurological
      > signs, that she was alert and oriented and had had a prior migraine headache
      > about a year before by her description with a negative cat scan at that time.
      > .He gave her injections of Demoral and Vistaril (two narcotics for pain) and a
      > prescription for Percocet another narcotic for pain to take at home and
      > discharged her
      >
      > On July 5, 1995 she called her family practice which was affiliated with the
      > hospital and described that the "migraine" started again after a bowel
      > movement. Talked with a resident who advised Tylenol or ibuprofen and if doesn't
      > get better call Dr. B, her regular doctor at the practice the next morning.
      >
      > July 6, comes into the practice to see her regular doctor and is seen by a
      > resident ., Dr. Z, who is completing his first year of residency having
      > graduated from medical school in Syria. He takes history of headache since July 1,
      > (by his note) slight nausea and loose stools. His note says no history of
      > vomiting. He does note that headache is general and not on one side (as
      > migraine's usually are) Thinks she has gastroenteritis, with secondary headache,
      > tells her to take Naprosyn. If not better in 48 hours call the office. There is
      > a note that he discussed the case with a senior physician who wrote if
      > headache not better in 48 hours get a Cat Scan. There is lack of memory as to
      > when this note was added to the chart.
      >
      > July 8, again during the night severe headache. Returns to the emergency
      > room. Dr. Z, the same resident that she saw the day before at the family
      > practice was on call. He saw her again noted that she had a severe, throbbing
      > headache and nausea and diarrhea. Diagnosed severe migraine. Did not order a
      > Cat Scan although one was readily available in the hospital. Did not have an
      > attending physician see her or review the chart before sending her home.
      > Injected her with same narcotics as before.
      >
      > July 10, called family practice and speaks to her regular doctor, Dr.B.,
      > with report of new headache, noted she had been seen in ER where they thought
      > migraine. Did not order a Cat Scan. Did not follow up.
      >
      > July 16, in church with her parents, when severe headache comes on again.
      > Parents take her home and call her sister who is a nurse. Sister calls family
      > practice and talks to a third year resident Dr. L. D. L tells them to keep
      > her at home and she prescribed two narcotics and a suppository for diarrhea
      > over the phone. Sister filled prescription. Sister made second call several
      > hours later. Dr. L still advises keep home. At about 7:30 P.M. sister and
      > roommate make decision to bring her to hospital despite Dr. L's advice. She
      > is admitted to evaluate her headache. Next morning a CAT scan is done which
      > show three major areas of bleeding two of which are confirmed to be 10 days to
      > 2 weeks old by subsequent MRI.. She had no neurological signs before July
      > 16, now has suffered significant cognitive deficits, and damage to right
      > side. Is totally disabled, and cannot resume her middle management job with a
      > large auto parts company.
      >
      > Plaintiff contends that there are three violations of standard of care.
      > First, no one did a differential diagnosis, listing the various possibilities
      > that could cause such severe headaches or evaluated whether she really had a
      > migraine. All doctors admitted that lay people frequently use the term
      > migraine to mean a bad headache which should still be evaluated as there are other
      > causes of bad headaches.
      >
      > Second, despite multiple opportunities to do so at emergency room visits or
      > family practice visits no one ordered a CAT Scan which was readily available
      > in the hospital, which was across the street from family practice, is
      > inexpensive, and is extremely sensitive to the presence of fresh bleeding in the
      > brain.
      >
      > Third there was a complete breakdown in communications between in the family
      > practice which ran a residency program for the hospital with no assurance
      > that senior doctors were seeing a complete record of this patients calls and
      > visits and failure to follow up to see how she was progressing and then order
      > appropriate treatment.
      >
      > The condition she had, vasculitis, is unusual for a 37 year old woman but
      > not unheard of , and more common for people over 50. It was highly treatable
      > with Prednisone and the plaintiff contends that had the Cat Scan been done
      > earlier and the blood seen, an appropriate diagnostic workup would have been
      > done, the condition recognized and high doses of Prednisone prescribed before
      > she suffered irreversible brain damage which does not appear to have occurred
      > until July 16-17. The Cat Scan would have revealed that she had a potentially
      > life threatening condition that would have had to have a serious evaluation
      > done to determine the cause.
      >



      [Non-text portions of this message have been removed]
    • jameswhitccc@aol.com
      Should be proof of negliance and malpractice by all who examined her. The facility as well should be named in a tort filing. Jim Whitby [Non-text portions of
      Message 2 of 2 , Jan 10, 2004
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        Should be proof of negliance and malpractice by all who examined her. The
        facility as well should be named in a tort filing. Jim Whitby


        [Non-text portions of this message have been removed]
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