Medication Error Leads to Significant, Irreversible Brain Injury ($1,500,000 Settlement)
Jane Doe has settled her medical negligence case against a rural Missouri hospital arising out of a medication error and a cascade of other errors that led to permanent cognitive impairment. 71 year old Ms. Doe was only a few hours removed from a total hip replacement when a registered nurse of the hospital administered 10,000 units of heparin. A pharmacist had mistakenly entered an order for this on the medication administration record. Heparin, a blood thinner, was contraindicated for the patient. The errant order led to Ms. Doe receiving a quantity of heparin equaling twice the normal dose.
Ms. Doe alleged additional negligence on the part of the nurses and physicians who failed to respond properly to her deterioration that followed. Ms. Doe began showing signs of distress starting about one and a half hours after she received the heparin. Her condition continued to deteriorate steadily over the next three and a half hours but neither the staff nurse nor the charge nurse who participated in the plaintiff’s care contacted a physician until the patient required transfer to the hospital’s intensive care unit. Various calls were made to Ms. Doe’s attending physician but neither that physician nor another physician whom a nurse contacted came to Ms. Doe’s bedside until some two hours after her transfer to the ICU and after she experienced a cardiopulmonary arrest from her undiagnosed and untreated bleeding complication.
Ms. Doe also alleged that hospital personnel negligently performed the Code Blue resuscitation that began when plaintiff arrested. After 30 minutes of attempting to revive Ms. Doe, resuscitation efforts were halted because the hospital personnel, including two physicians, thought that Ms. Doe could not be revived. However, resuscitation resumed after a nurse noted Ms. Doe’s gasping for air. Three minutes passed between the halt and the resumption of resuscitation.
Ms. Doe was diagnosed with renal failure, shock liver and encephalopathy. Plaintiff alleged that the late response to Ms. Doe’s bleeding complication, which severely depleted her blood volume, together with the three minute interruption in resuscitation had caused these injuries.
Ms. Doe was transferred to a large urban hospital within 36 hours and she soon thereafter recovered kidney and liver function. Nevertheless, she remained in a near comatose state for nearly two weeks. An EEG revealed mild to moderate abnormality to her brain, but CT and MRI scans were normal. Various physicians at the transferee hospital charted that Ms. Doe fully recovered from her encephalopathy and had sustained no lasting cognitive impairment.
A neuropsychologist retained by Ms. Doe’s attorney tested Ms. Doe at 6 months and again at 20 months after her bleeding complication. Testing on both occasions revealed Ms. Doe to have above average problem-solving ability but showed her working memory to be in the lowest two percentile.
In addition to cognitive injury, Ms. Doe alleged that her brain injury had altered her senses of taste and smell.
Plaintiff entered into a $1.5 million settlement with a limited confidentiality agreement.
Failure to Diagnose Spinal Epidural Abscess ($1,000,000 Settlement)
Our client, a 59-year-old male, experienced episodic, low back pain during a six month period. His pain, mild at the outset, gradually increased to excruciating. Symptoms included fever and chills. Client sought treatment from his primary care doctor and an orthopedist and twice was admitted into a hospital for evaluation. Nevertheless, client’s true diagnosis remained undetected. Finally, a specialist, who conducted an extensive review of client’s history, determined that client might have a spinal epidural abscess in the dura of his spine. Spinal epidural abscess (SEA) represents a neurosurgical emergency. SEA is a rare diagnosis. Medical literature states that it is seen in one in ten thousand admissions. Nevertheless, if an SEA is suspected an immediate MRI must be conducted to confirm the diagnosis and emergent, evacuation surgery must follow. Failure to emergently remove an SEA can lead to paralysis or death. No MRI or evacuation surgery occurred until client sustained irreversible neurologic injury which substantially impaired the client’s ability to walk.
Dempsey and Kingsland action:
We acquired all of client’s medical records for the previous 5 years. We retained a renowned neurologist, Maurice Victor, who is known as the “Father of Modern Neurology” to assist us in our review of the case. We also retained three other well-credentialed physicians to testify on client’s behalf. We filed suit against five physicians who participated in client’s treatment. We utilized the theme that client’s diagnosis was diagnosable and, in fact, was diagnosed but left untreated until client had sustained irreversible injury.
On the eve of trial, the case settled for $1,000,000 with all five physicians funding the settlement.
Eighteen Wheel Truck/Passenger Vehicle Collision Results in Death ($5,000,000 Settlement)
A 55 year old female died when her disabled vehicle that partially occupied a lane of traffic was struck by an eighteen wheel truck on a highway located in Jackson County. We brought suit on behalf of her three emancipated children.
Dempsey and Kingsland action:
We obtained a complete copy of the extensive police file concerning the investigation of the collision. We also investigated the trucking company and the truck driver. We obtained a download from the “black box” of the eighteen wheel truck that revealed that the truck was speeding and that the truck driver had not applied the brakes of the truck until the collision happened. We also obtained proof that the truck driver had a previous felony conviction arising out of the use of eighteen wheel trucks to smuggle cocaine across the border from Mexico. We located a witness to the crash by obtaining an audio recording of 911 telephone calls that were made in connection with the collision. This witness, together with another witness that who was identified in the police report, was able to confirm that the truck driver had a clear view of the disabled vehicle from approximately a quarter of a mile away but failed to take any action to make a lane change to avoid the collision. We produced an animation based on the witness accounts and other evidence that depicted how the collision occurred. This animation highlighted the truck driver’s inattention that led to the crash.
The case settled after mediation for the trucking company’s policy limits of $5,000,000.
Hospital Technicians Cause Client’s Paraplegia ($850,000 Settlement)
Client had recently retired from a blue collar job because he had structural vulnerability in his spine due to severe osteoporosis and severe ankylosing spondylitis which caused his spine to degenerate. These two diagnoses had caused client’s spine to become brittle and prone to fracture. They had also caused client’s spine to degenerate such that he had developed a massive humpback. Client experienced severe mid-back pain during a coughing spell and sought treatment. Client was hospitalized and a neurologist ordered cervical x-rays. The radiology technicians who performed the cervical x-rays while client lay on a radiology table experienced difficulty obtaining cervical images. The technicians apparently decided to attempt to straighten client’s spine with one technician pushing on client’s shoulders and the other technician pushing on client’s legs in a misguided attempt to obtain better cervical images. (It appears that the radiology technicians did not realize that client had a humpback condition and was vulnerable to injury.) This levering pressure resulted in client sustaining a displaced, through and through fracture in his thoracic spine resulting in paraplegia.
Dempsey and Kingsland action:
We obtained client’s hospital chart which confirmed that client had undergone cervical x-rays and that client’s paralysis soon followed his visit to the hospital’s radiology suite. Client’s chart failed to provide any information or explanation as to how his spine had been fractured such that he was rendered paraplegic. We filed suit against the two radiology technicians and the hospital and we deposed all hospital employees including the two radiology technicians. All emphatically denied any knowledge of client’s injury. The Joint Commission on the Accreditation of Hospitals requires that hospitals prepare incident reports for all sentinel events. (A sentinel event is one in which a patient experiences a substantial, unexpected change in health status during hospitalization). The hospital became motivated to settle the case when we cited the failure of the hospital to prepare an incident report on client’s sentinel event. We also cited an entry from the diary of client’s wife along with her testimony. Client’s wife was outside the radiology suite when client sustained his spinal injury. She did not see the radiology technicians’ actions but she had heard her husband shouting: “No, stop,” and heard him scream in pain. She recorded this description of events in her diary. We developed an animation to show how the pushing action of the radiology techs had caused client’s displaced spinal fracture. Our investigation revealed a weakness in the case. A CT scan performed before the incident involving the radiology technicians revealed a fracture (apparently caused by client’s coughing spell). The fracture became displaced at the point when the technicians attempted to straighten client’s spine.
The case settled for $850,000 with the agreement that the hospital’s identity would remain confidential.
Patient’s Sudden Cardiac Death Follows Hospital Discharge Without Protective Device that Patient’s Cardiologists Had Recommended ($700,000 Settlement)
The family of John Doe has settled a wrongful death case against a physician arising out of communication errors that culminated in Mr. Doe’s dying from cardiac arrhythmia. Mr. Doe’s death occurred after he was discharged from a Missouri teaching hospital without a commonly prescribed wearable device that administers a defibrillator shock to the heart to restore normal heart rhythm when the patient experiences certain types of cardiac arrhythmias. One of the many physicians who participated in Mr. Doe’s care had recommended this device to Mr. Doe and Mr. Doe had specifically requested it. Nevertheless, none of Mr. Doe’s physicians placed an order for the device from the manufacturer. The defendant physician authorized Mr. Doe’s hospital discharge without the device despite Mr. Doe’s cardiac status that placed him at high risk for a fatal arrhythmia. Four days after discharge, Mr. Doe experienced sudden arrhythmia and he collapsed at his home. A family member called 911 and ambulance personnel responded. All efforts to revive Mr. Doe failed. In addition to settling the case for $700,000, the hospital that employed the defendant physician announced that it has taken measures to improve communication between hospital personnel.
Mr. Doe, a 58-year-old married father of two emancipated children, initially presented to the subject hospital emergency department with aphasia (difficulty with speech). His work up confirmed that he had experienced a stroke and Mr. Doe was admitted into the care of the neurology service. Additional testing confirmed that Mr. Doe had sustained a recent myocardial infarction that reduced his ejection fraction to 25% to 30%. (Ejection fraction is a measurement of the amount of blood that is pumped out of the heart with each contraction. Normal ejection fraction ranges from approximately 55% to 65%.) Cardiology physicians were called in to consult in Mr. Doe’s care in light of the determination of recent myocardial infarction.
It is well established that ejection fraction below 40% places the patient at high-risk for developing a fatal cardiac arrhythmia. In this circumstance, the recommended treatment is surgical implantation of a cardioverter-defibrillator that can correct most cardiac arrhythmias. However, implantation is commonly delayed with patients who have experienced a recent myocardial infarction to allow for recovery from the myocardial infarction which may result in improved ejection fraction to a level such that an implantable cardioverter-defibrillator is unnecessary. Zoll Medical Corporation is the exclusive manufacturer of wearable cardioverter-defibrillators (LifeVests).
On the second day of his five day hospitalization, one of Mr. Doe’s cardiologists “highly recommended” that Mr. Doe use a LifeVest to protect him from the time of hospital discharge up until re-evaluation of his ejection fraction. Mr. Doe immediately requested the cardiologist to order the LifeVest but, as mentioned, no order was placed by that physician nor by any of the many physicians who participated in Mr. Doe’s care.
Mr. Doe was scheduled for discharge on his fourth day of hospitalization but he was kept an extra day to allow for delivery of the LifeVest. When the Lifevest still had not arrived on day five of Mr. Doe’s hospitalization, the defendant physician discharged Mr. Doe, advising him that the LifeVest would arrive at his home “the next day.” (The discharging physician was apparently unaware that the LifeVest was never ordered from the manufacturer.)
Upon discharge, Mr. Doe returned to his home in northern Indiana with family members. The LifeVest did not arrive the next day nor did it arrive on post-discharge days two and three. Mr. Doe died during the early morning hours of post-discharge day four. The defendant physician asserted Mr. Doe was comparatively at fault for failing to contact anyone at the hospital about the LifeVest not having been delivered as promised which diminished the verdict potential of the family’s claim.
Paraplegia Due to Improper Administration of Blood Thinner (Confidential Settlement)
Our client, an 82-year-old retired but active female, sustained a complication in connection with the implantation of a neurostimulator. Pre-implantation, the client had experienced a long history of lumbar pain which was refractory to physical therapy, trigger point injections and medication. After undergoing a neurostimulator trial which substantially reduced her pain, client elected to undergo surgery for permanent implantation. The defendant surgeon ordered a blood thinner, Lovenox, post-surgery. Ten hours after Lovenox was administered to the client, she lost motor function in both legs. The client also lost urinary control. The pharmaceutical company that manufactures Lovenox warns that Lovenox must be used with “extreme caution” on patients who have had a history of spinal surgery as there exists risk of spinal hematoma and paralysis. An exploratory surgery performed approximately two hours following the onset of our client’s lower extremity paralysis failed to yield an explanation. A second exploratory surgery performed about twenty-four hours after the onset of paralysis led to the discovery of a hematoma in the client’s thoracic spine. Unfortunately, evacuation of the hematoma did not restore function.
The terms of the settlement are confidential.
Malpositioning of Catheter Results in Brain Damage (Confidential Settlement)
P. B. was born ten weeks premature and required supplemental oxygen and feeding via an umbilical venous catheter (UVC). Infants who are born premature often cannot be fed orally. They are fed nutritional fluid via a catheter which is placed through an umbilical vein. A UVC must be carefully placed. The tip of the catheter should be positioned just below the right atrium of the heart. Before placement is attempted, exterior measurements are made (such as from the shoulder to the navel) to determine the proper length for the internal positioning of the catheter. The UVC is then placed and a chest x-ray is performed to confirm proper positioning of the catheter tip. Right atrium placement of a catheter tip poses catastrophic risk. The heart of a premature newborn beats at a rate of approximately 140 beats per minute. When a catheter tip is placed within the newborn’s heart, repeated contact between the catheter tip and the heart wall will result in the tip burrowing through the heart wall such that the tip enters the pericardium (the cavity into which the heart beats). When nutritional fluid is directed into the erroneously placed UVC, the fluid empties into the pericardium (the cavity into which the heart beats). When the pericardium fills with fluid, the heart is no longer able to beat and blood flow comes to a stop. Cessation of blood flow results in damage to organs including the brain which require a continuous supply of oxygen rich blood.
An interning physician working under the supervision of a neonatologist miscalculated the measurement for the placement of the UVC that was placed in P. B. and as a result the catheter tip was positioned inside the right atrium of the child’s heart. The radiologist who reviewed the chest x-ray noted the faulty positioning of the UVC and warned that the UVC needed to be withdrawn from the right atrium. Unfortunately, this warning went unheeded and the newborn sustained brain damage from interrupted blood flow.
Dempsey and Kingsland action:
We obtained the hospital records and films and took depositions of the health care providers who participated in P. B.’s care to confirm the above facts. In reviewing the hospital’s chart, we noted that the record which described the UVC placement recited that the placement was performed “pursuant to unit protocol.” We requested this protocol be produced for our review but the hospital refused, denying that the protocol existed. After the Judge reviewed our motion to compel production of the protocol and heard argument from the parties, the judge ordered the hospital to produce the protocol or face sanctions. It became apparent that the hospital refused to produce the protocol because its placement of the UVC in P. B. squarely violated the protocol’s directives. We also developed an animation to show how a UVC should be placed so as to prevent injury. The animation also showed how an erroneously placed UVC results in perforation of the heart wall, fluid collection in the pericardium and then cessation of heartbeat interrupting blood flow and resulting in damage to the brain and other organs.
The case settled pursuant to an agreement which requires that the settlement amount remain confidential.
Other Case Stories
Browse the links below to explore more case stories from the attorneys of Dempsey & Kingsland, P.C.
- Gynecologic Surgery Complication Case–$950,000 Settlement
- Patient’s Sudden Cardiac Death Follows Hospital Discharge Without Protective Device that Patient’s Cardiologists Had Recommended ($700,000 settlement)
- Medication Error Leads to Significant, Irreversible Brain Injury ($1,500,000 settlement)
- Eighteen wheel truck/passenger vehicle collision results in death ($5,000,000 settlement)
- Failure to Diagnose Spinal Epidural Abscess ($1,000,000 settlement)
- Chronic pain injury sustained because of fall due to dangerous condition ($1,000,000 settlement)
- Paraplegia due to improper administration of blood thinner (Confidential settlement)
- Brain injury from electroshock ($900,000 settlement)
- Amputations of certain fingers and all toes because of bowel perforation from gallbladder surgery ($850,000 settlement)
- Severe injuries to mother and daughter from head on collision (1,200,000 settlement)
- Hospital technicians cause client’s paraplegia ($850,000 settlement)
- Failure to diagnose hip dysplasia in newborn ($625,000 settlement)
- Malpositioning of catheter results in brain damage (confidential settlement)
- Truck car collision results in low back injury ($600,000 settlement)
- Psychological injury to child from abuse at daycare ($600,000 settlement)