Re: The strange case of Ms. S: can you guess the defense?
- In a message dated 1/10/2004 11:56:56 AM Eastern Standard Time, JuryDoctor
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> 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.
> 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
> 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.
- 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
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