Newborn given overdose of anti-seizure drug
March 23, 2010
A baby was born by Caesarian section on Sept. 7, 2002, at 38 weeks gestation, after three days of labor induction due to difficulties in the pregnancy.
Two days later, the baby developed seizures with episodes of apnea and was transported to a separate hospital’s neonatal intensive care unit.
Over the next two days, the newborn continued to have multiple seizures with tongue rolling, lip smacking, jerky uncoordinated movements of all extremities and apnea, despite treatment with the anti-seizure drug Phenobarbital. Doctors decided to administer a second medication, Dilantin, in hopes of controlling the seizures.
On Sept. 11, a nurse administered the medication to the baby by vein rather than intramuscularly, as had been ordered by the doctor. The baby developed apnea, mild bradycardia, distant heart sounds, weak peripheral pulses, poor tone, poor perfusion and cold extremities.
He was intubated and placed on a ventilator. His arterial blood gases reflected moderate metabolic acidosis. He received saline for his hypovolemia and hypoperfusion and medications to increase his blood pressure. He responded with an increase in his heart rate and blood pressure. His color, perfusion and oxygen saturation improved as well.
Blood tests showed an elevated level of Dilantin, which gradually went down over a few days. The baby was then taken off the ventilator and was able to breathe on his own, and he was noted to have normal heart, kidney, liver and lung function.
Over the course of the next seven years, the child went on to demonstrate residual cognitive impairment and was diagnosed with autism. The parents claimed the injuries were a result of the Dilantin overdose.
The defense conceded that the baby had been given too much Dilantin but contended that it cleared quickly and the baby suffered no resultant harm. They further contended that the baby was brain-damaged long before the Dilantin episode, as evidenced by abnormal head studies performed prior to the overdose, and that his current condition was entirely unrelated to the Dilantin.
The case settled for $6 million.
Type of action: Medical malpractice
Injuries alleged: Cognitive defects due to overdose of Dilantin
Date: January 2010
Submitted by: Andrew C. Meyer and William J. Thompson, Lubin & Meyer, Boston
Nurse, midwife fail to expedite C-section
March 23, 2010
On July 18, 2003, the patient, who was expecting her first child, was admitted early in labor to the hospital with intact membranes. She came under the care of a certified nurse midwife and obstetrical nurse that evening.
For at least four hours prior to delivery, the baby demonstrated fetal heart rate patterns indicative of a worsening fetal oxygenation status, particularly in the final two hours. Neither the nurse nor the midwife monitored the readings or called a supervising physician. The nurse did not check the maternal pulse to assure that the fetal monitor strip was recording the fetal heart rate rather than the maternal heart rate.
Five hours into the mother’s stay, the nurse called the pediatrician, as she realized that she was recording the mother’s pulse instead of the baby’s heart rate for at least 40 minutes.
The baby was born limp and cyanotic with no respiratory effort. She was intubated and transferred to the level II nursery, where she suffered seizures before being transferred to another facility.
She was diagnosed with hypoxic ischemic encephalopathy and status epilepticus. She was transferred to another hospital and stayed there until November, when she was transferred to another facility. She was eventually sent home and remains under the care of her mother.
The parents’ experts were expected to testify that fetal hypoxia was present for a significant period of time prior to delivery and that there is no evidence of any alternative etiology for the HIE. The radiological findings indicate that the injury occurred before delivery.
The child, now six years old, suffers from spastic quadriplegia and significant cognitive, language, communication and motor delays. She will always be dependent on others for her daily activities, including personal hygiene, feeding, dressing and mobility.
The case settled for $4 million.
Type of action: Medical malpractice
Injuries alleged: Hypoxic ischemic encephalopathy, permanent brain injury
Date: November 2009
Submitted by: Philip J. Crowe and Florence Carey, Crowe & Mulvey, Boston
Doctors accused of inserting catheter too forcefully
March 23, 2010
The patient was a 59-year-old man who had a history of high cholesterol and smoking.
He began to experience cramping in his left calf after walking a short distance and was referred to a vascular surgeon for an evaluation.
He was diagnosed with moderately severe vascular occlusive disease. After a trial of the medication Trental, he had an absent pulse in his left foot. Testing revealed a distal superficial femoral artery popliteal occlusion.
The physician performed a surgical bypass. The plaintiff had had no urinary problems prior to surgery. After the spinal tap was placed, the circulation nurse attempted to place a Foley catheter, without success. The surgeon made a second attempt at passing the Foley catheter and noted in his operative report that it went in without resistance, producing a drop of fluid in the catheter. The 5cc balloon was inflated without resistance and the surgery was performed.
After surgery, the patient did not have any urine output. He was markedly distended and there was blood at the meatus. His rectal exam identified a boggy prostatic area with approximately 30 grams of smooth, benign prostate.
A cystoscopy revealed an area of extreme trauma past the urethral sphincter. No tract was identifiable past the prostatic urethra into the bladder; instead, an unidentifiable tract, through which the cystoscope was negotiated, continued from the bulbar urethra to the rectum. The scope was able to be passed from the urethra out through the anus.
Multiple attempts were made at passing the cystoscope from the penile urethra into the bladder, without success. There was a complete urethral disruption. A transvesical realignment was performed and a connection from the urethra to the bladder neck was re-established.
The patient underwent a procedure to repair the area and was discharged with a colostomy, which was later reversed. He has scars on his leg and abdomen.
The patient alleged that the surgeon and nurse deviated from the accepted standard of care when they used excessive force to insert the Foley catheter.
Both defendants claimed that the catheter was confirmed to be in the bladder before it was inflated because of the feel during the insertion, the length of catheter inserted and the return of urine. They argued that the perforation was a risk of the procedure.
The case settled for $850,000.
Type of action: Medical malpractice
Injuries alleged: Failure to properly place catheter during surgery causing perforated bladder and
resulting urinary problems
Date: November 2009
Submitted by: Elizabeth N. Mulvey and Michael J. Harris, Crowe & Mulvey, Boston
Woman suffers infection years after splenectomy
March 23, 2010
The patient underwent a splenectomy in 1995. Following the procedure, she received a pneumovax vaccination. She did not receive a Hemophilus or Meningiococcal vaccination.
In April 2001, the patient, then 35, began seeing a new doctor for her primary care. She saw the physician on two occasions and a nurse practitioner on four occasions. Neither of them recommended or administered a pneumococcal revaccination.
The plaintiff developed a pneumococcal infection that required a three-month hospitalization and a two-month stay in a rehabilitation residence. During her hospital admission, the plaintiff became septic, suffered organ failure and necrosis, and had to undergo partial amputation of her toes. She suffers from chronic infection and pain.
The patient contended that considering her asplenia, the standard of care required the defendants to revaccinate her.
The defense team argued that all of the visits were acute sick visits rather than annual preventative and wellness physicals. They claimed that this did not provide them with an opportunity to recommend or administer a pneumococcal vaccination.
The defendants also opined that a pneumococcal vaccination is not the standard of care, is not proven to be effective, would not necessarily have prevented the patient’s variant of pneumococcal infection and had not been recommended by other non-party physicians.
The case settled for $3 million after a second mediation.
Type of action: Medical malpractice
Injuries alleged: Failure to administer pneumococcal vaccine resulting in sepsis, organ failure and necrosis
Date: September 2009
Submitted by: Philip J. Crowe Jr. and Michael J.
Harris, Crowe & Mulvey, Boston
Warning signs for fatal heart attack are missed
June 14, 2008
Early one morning in 2004, a married, 45-year-old mother of two woke up with excruciating pain in her right shoulder going into her arm.
The woman was seen at a local health center later that morning by a nurse practitioner and a doctor. The doctor’s notes from the examination indicated that the patient had pain on her right side going toward her upper back. The record further indicated that she had not experienced any trauma or performed any physical activity that would account for her pain.
Parents, physicians settle over missed cystic fibrosis in fetus
June 14, 2008
During the course of a couple’s pregnancy, both parents were found to be genetic carriers of cystic fibrosis. Their OBGYN referred them to a geneticist for counseling.
Radiologist could assume staff would communicate findings
June 14, 2008
The patient, a 69-year-old male with a history of congestive heart failure and diabetes, presented to his primary care physician on Dec. 19, 1998 complaining of cold-like symptoms.
State, Merck reach $10.5M settlement
March 17, 2008
The state Attorney General’s Office has reached a $10.5 million settlement with drug maker Merck & Co. to settle a case involving drug rebates under Medicaid, according to the State House News Service.
Patient develops infection from gauze in wound
March 17, 2008
A 77-year-old man was a hospital patient from April 2004 to June 2004, during which time he underwent three spinal disc surgeries.
Woman treated for HIV though she didn’t have the virus
March 17, 2008
A woman was diagnosed as HIV positive in 1994 by anonymous testing and reported her results to her gynecologist, who referred her to an HIV specialist at the University of Massachusetts Medical Center. Read more
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