Multiple cases of medical malpractice committed by several doctors including 3 neurosurgeons almost killed a patient according to a recent article written by Sandra Boodman in the Washington Post. Brad Chesivior from Maryland almost died after several doctors failed to diagnose a brain bleed. When a neurosurgeon finally made the proper diagnosis, the acute subdural hematoma that he was suffering from was as large as the size of an adult’s palm and was threatening to kill him. According to the neurosurgeon who made the proper diagnosis, Bard had probably no more than 24 hours to live and needed immediate surgery.
In the article the author describes how multiple doctors misdiagnosed the 60 year old man to the point that he almost died. The first significant symptoms appeared just after Thanksgiving 2013. Chesivoir suddenly became very weak and unable to walk. He was transported by ambulance to a Maryland emergency room. As he arrived at the ER he felt better and was able to walk again. The ER staff performed CT and MRI brain scans as well as multiple blood tests. Doctors thought that he was the victim of a heart attack or a stroke but tests didn not show any of these. They completely missed evidence of multiple bleeds and sent Chesivior home with a diagnosis of headache. They told him he should consult with his internist. Chesivior went to see his internist who recommended he sees a neurosurgeon. The neurosurgeon looked at the previous scans made at the ER and missed the bleeds too. Instead she ordered additional tests and scheduled a follow up appointment almost two months later. In between, Chesivior’s headaches got worse. When they got even worse, he consulted with another neurosurgeon as his neurosurgeon was out of town. The second neurosurgeon told him that his problem was a typical migraine and prescribed amitryptiline. A few days later he developed double vision. The neurosurgeon told him it was an adverse effect from the medication and reduced his dose. The problem got worse. Two days later, he went to consult with a ophthalmologist who told his wife to drive him immediately to the ER where a fourth neurosurgeon finally proprely diagnosed the problem and saved him from death by operating on him the following day.
Among the various types of medical malpractice suffered by hospital patients, misdiagnosis accounts for approximately 10% of patient deaths. In a recent Opinion Page from the New York Times, Sandeep Jauhar, a Long Island cardiologist, wants to Bring Back the Autopsy as a weapon to fight misdiagnosis.
With the evolution of medicine and the proliferation of medical tests, autopsy doesn’t seem as essential these days as it was in the past to determine the cause of death of a patient. Before 1971, community hospitals were required to perform autopsies on 20% of their dead patients to earn their accreditation from the Joint Commission. This requirement was dropped after that date. Furthermore in 1986, Medicare considered autopsies financially draining and stopped paying for them. Now an autopsy is mostly considered by doctors as an educational tool.
Recent studies however have demonstrated that despite the medical technological advances autopsy can be a very effective manner to reduce the rate of hospital misdiagnosis. In his opinion Sandeep Jauhar suggests that Medicare and private insurers pay for them again so that financial considerations doesn’t limit their use.
In a recent article, Sandra G. Boodman from the Washington Post writes about the case of a man whose doctors failed to diagnose Familial Mediterranean Fever (FMF) for months until he consulted with a well traveled gastroenterologist who suspected FMF. FMF is a disorder caused by a gene mutation. this disorder is known to affect Sephardic Jews, whose ancestry is Middle Eastern, as well as non-Jews from the Middle East, Italy and Armenia.
43 year old Jeffrey Sank suffered from recurrent abdominal pain for nearly a year. At the beginning attacks were intermittent but after several months the pain increased in severity and intensity. Jeffrey visited with multiple doctors including two gastroenterologists, a kidney specialist and an infectious-disease physician. The infectious-disease specialist suspected he had FMF but but did not pursue it after Sank told him he wasn’t of Middle Eastern descent. The last gastroenterologist he saw also suspected it was FMF and even though Sank again denied any Middle Eastern descent again, he decided to prescribe him colchicine, a mainstay therapy for FMF. The drug worked immediately and the abdominal attacks almost stopped. Later on genetic tests demonstrated that Sank had indeed inherited mutated genes from both his parents.
Failure to diagnose or to treat priapism, a medical condition of prolonged penile erection that is unrelated to sexual stimulation, can result in serious complications such as permanent erectile dysfunction or disfigurement of the penis. Priapism is not very common but as a result of the use of erectile dysfunction medication the potential for serious complications from Priapism is on the rise. Other medications such as intracavernosal agents, some antihypertensive agents , some psychotropic drugs, anticoagulants, cocaine, certain hormones, and ginkgo Biloba are also known to cause priapism. Diseases such as sickle cell disease can also cause this painful medical condition.
When a patient suffers from priapism it is crucial that the doctor determines if it is a case of ischemic or nonischemic priapism. Ischemic priapism is a medical emergency that requires immediate treatment. Usually the patient will receive an intracavernous injection of an alpha-adrenergic sympathomimetic agent followed by a surgical shunting procedure if necessary. Nonischemic priapism is not considered an emergency and will usually resolve by itself without treatment.
In its “Case of the Month” the Journal of the American Academy of Physician Assistants looks at the case of a middle aged patient who was diagnosed with ischemic priapism associated with trazodone use. Read the complete article here
Failure to diagnose or delay to treat herpes simplex in the eye area can result in serious personal injury such as episcleritis, keratopathy, iritis, blepharitis, conjunctivitis, uveitis, keratitis, retinitis, optic neuritis, glaucoma, proptosis, cicatricial lid retractions, and extraocular muscle palsies. In “case of the month: a lesion near the eye”, the Journal of the American Academy of Physician Assistants looks at the case of a 19-year-old man who visited his healthcare provider with erythema and irritation of the skin adjacent to his right eye. The patient noted the irritation for the first time after a military exercise in a sandy environment. Read the case here
In 2001, Pam Tusiani died as a result of Medical Malpractice in New York after she fatally reacted to Parnate, an antidepressant she had been prescribed by a treatment center that was providing medical care without a license. The young woman was suffering from borderline personality disorder, a disease often misdiagnosed.
Using the settlement from their malpractice suit, Pam’s parents started the Borderline Personality Disorder Resource Center at New York Presbyterian Hospital in 2003. Last July the Tusianis hosted some of New York’s top neuroscientists and psychiatrists at a day-long event to review the latest science on BPD and devise new avenues for research.
Read more in The Washington Post
The law in New York State requires victims of medical malpractice to file their claim within 15 months after medical malpractice occurs at a public hospital and 2 1/2 years against a private hospital or physician. Lavern’s Law proposes to start the statute of limitations from the time a patient discovers the malpractice rather than from the time the medical malpractice occurs. Lavern’s Law is named after Lavern Wilkinson who died from a curable form of lung cancer after doctors at Kings County Hospital in Brooklyn, NYC, failed to tell her that a chest X-ray they took in 2010 showed a small, suspicious mass on her right lung and instead sent her back home with Motrin. Lavern only discovered that she had cancer when she was terminal. By that time, the statute of limitations had expired and she wasn’t able to sue the hospital for failure to diagnose lung cancer. She died leaving behind her a daughter who was severely autistic. The city settled Wilkinson’s lawsuit, for $625,000 the day she died, March 7, 2013. Medical malpractice experts said her case would have netted over $10 million had it not been for the statute of limitations. Yesterday Governor Cuomo gave his support to the law. Read more in the NY Daily News
Failure to diagnose neurosarcoidosis can be medical malpractice that can drastically impair the quality of life of a person. In its “Case of the Month” , the Journal of the American Academy of Physician Assistants (JAPA) discusses the case of a 68 year old woman who’s condition severely worsened after she was misdiagnosed. In 2011 the patient complained to her neurologist that she had difficulties walking. The neurologist’s diagnosis was normal pressure hydrocephalus and had a ventriculoperitoneal shunt placed to drain the increased Cerebrospinal fluid. The condition of the patient seemed to improve at the beginning but after two years the symptoms worsened and she developed double vision and couldn’t walk without a cane. The neurologist thought the problem was coming from the shunt and tried different adjustments that were unsuccessful. The patient was using a walker and suffered from ataxia, weakness and increased urinary incontinence when she decided to consult with a neuromuscular clinic. The patient was diagnosed with a rare condition called neurosarcoidosis. The patient received cortocosteroids and her condition started to improve after 5 days.
Read the complete case in the Journal of the American Academy of Physician Assistants (JAPA)
In 2011, the family of 82 year old Pasqualre Vaglio from New York sued a cruise line for medical malpractice after the medical staff on board failed to diagnose a brain injury that would lead to the death of the man a few days later. Medical malpractice lawsuits against cruises have been for a long time impossible to win as cruise lines would use various exemptions created by previous court decisions. One of these exemptions known as “Barbetta” held in 1988 that passengers should not expect the same type of medical care on a ship as on land and ships’ doctors and nurses were private contractors beyond the cruise lines’ direct control. In the recent Vaglio case, a three-judge panel of the 11th U.S. Circuit Court of Appeals – which has jurisdiction over the major Florida-based cruise lines – recently held Barbetta is outdated law. The judges said that the doctors and nurses on the cruise line were wearing the cruise uniforms and were held out as ship employees in the promotional material of the cruise line. They also opined that cruise lines these days have sophisticated ICUs and laboratories. They can video conference with medical experts if necessary.
Read more in the New York Times