James P. Koch
1101 St. Paul St.
Suite 404
Baltimore, MD 21202
Telephone 410 539 7816
Fax 410 539 3957
Medical Malpractice (urology): Failure to diagnose necrotizing fasciitis (Fournier’s gangrene); wrongful death
Medical Malpractice (podiatry): Nerve injuries to foot; reflex sympathetic dystrophy (RSD)
Medical Malpractice (gynecology): Abdominal hysterectomy complications; sepsis and scarring
Hospital Negligence (nursing): Failure to monitor patient's respiratory status; plugged tracheostomy tube; patient asphyxiates and dies
Hospital Negligence (nursing): Patient with spinal cord condition injured in fall; central cord syndrome
Medical Malpractice (general surgery): Plaintiff's verdict for delayed treatment of bowel obstruction; adult respiratory distress syndrome (ARDS); neuropathies Click here for newspaper coverage of this case
Medical Malpractice (orthopedics): Failure to diagnose surgical wound infection following spine surgery; chronic vertebral osteomyelitis
Long Term Disability Insurance: Federal judge chastises UnumProvident Corporation for terminating long term disability benefits of woman with end stage congestive heart failure Click here for Mr. Koch's comments about this case reported in the Wall Street Journal.
Long Term Disability Insurance: Another UnumProvident case; insurer misconstrued results of functional capacity examination in order to terminate client's disability benefits
Health Insurance: Federal judge orders reinstatement of health insurance benefits for woman undergoing treatment for chronic schizophrenia
Click here for list of additional cases which resulted in published court decisions
Failure to diagnose necrotizing fasciitis (Fournier’s gangrene)
The decedent, a 66 year old retired postal worker with a history of congestive heart failure, obesity, and diabetes, presented at his urologist’s office with a three day history of severe pain and a grossly swollen scrotum the size of a cantaloupe. The urologist, based on a cursory physical examination, attributed the swelling and pain to edema caused by the decedent’s heart condition. He sent the decedent home with instructions to rest and to call his cardiologist if his symptoms got worse. The decedent collapsed and died the next day. At autopsy, the cause of death was confirmed to be septic shock secondary to Fournier’s gangrene.
Fournier’s gangrene is a form of necrotizing fasciitis, commonly referred to as flesh eating bacteria. This kind of serious infection can progress in a matter of hours to life threatening sepsis. Fournier’s gangrene is an absolute urological surgical emergency.
The basis of the malpractice case was the urologist’s failure, in light of the patient’s multiple pre-existing medical conditions and his serious presenting symptoms, to obtain an immediate emergency room evaluation (including complete blood work, cultures, and diagnostic studies). Such an evaluation would have revealed the necrotizing process. The decedent most likely would have survived if the necrotizing process had been diagnosed in a timely manner and treated as a surgical emergency.
This case was settled prior to trial at mediation for a confidential amount satisfactory to the decedent’s family.
Plaintiff, a 40 year old Prince George’s County woman, developed a painful bump on the top of her left foot after dropping a ceramic bowl on it. Plaintiff’s family doctor ordered an xray of the foot, which showed no fracture or other abnormality of the bones or joints. The family doctor diagnosed the bump to be a soft tissue cyst. He referred the plaintiff to the defendant podiatrist for further treatment.
Even though the xray was normal, the podiatrist diagnosed the bump to be an exostosis, a bony growth on the surface of a bone. The podiatrist recommended immediate surgery to remove the exostosis. During the surgical procedure, the defendant caused traumatic injury to plaintiff’s deep and superficial peroneal nerves, resulting in neuritis. These injuries necessitated a subsequent surgical procedure to sever the affected nerves. Severing the injured nerves, however, did not alleviate plaintiff’s pain syndrome. Instead, plaintiff went on to develop reflex sympathetic dystrophy (RSD), an incurable and disabling post-traumatic chronic pain syndrome.
The allegations of negligence in this case included the podiatrist’s misdiagnosis of the condition affecting plaintiff’s left foot; failure to treat plaintiff’s condition conservatively before attempting surgery; performing unnecessary surgery; and surgical error resulting in traumatic nerve injuries to the deep and superficial peroneal nerves.
This case was settled prior to trial at mediation for a confidential amount.
Abdominal hysterectomy complications
The plaintiff, a 40 year old Harford County woman, developed life threatening septic shock less than 24 hours after undergoing a routine, elective abdominal hysterectomy. In order to determine the cause of this rapidly progressive infection, her surgeon had to perform exploratory abdominal surgery. During this subsequent procedure, the surgeon lacerated the patient's bladder.
The basis of the malpractice claim was the defendant gynecologist's failure to adhere to well established clinical practice guidelines which required him to administer prophylactic antibiotics prior to the abdominal hysterectomy. If the patient had received prophylactic antibiotics, she most likely would not have developed sepsis and other serious complications, which included a disfiguring abdominal scar, vesico-vaginal fistula, persistent urinary tract infections, pelvic adhesions, and post-traumatic stress disorder. This case was settled for a confidential six figure amount shortly prior to the commencement of trial in Baltimore County.
Tracheostomy patient asphyxiates and dies
The decedent, a 68 year old Baltimore woman with a complicated medical history, was hospitalized with breathing difficulties secondary to a constricted airway. In order to open her airway, she received a tracheostomy. The medical condition which had caused the constricted airway, a blood infection, was successfully treated during the hospitalization. However, on the day before her scheduled discharge, decedent asphyxiated when a mucous plug obstructed her tracheostomy tube. The asphyxiation led to respiratory arrest, severe hypoxic brain damage, and ultimately death.
The basis of this lawsuit was the nurses' failure to adequately monitor the patient's respiratory condition. This patient required constant monitoring because she had, during the 24 hours prior to the respiratory arrest, experienced several episodes of respiratory distress caused by a plugged tracheostomy tube. The nursing staff therefore knew or should have known that the patient's respiratory condition put her at high risk for airway obstruction and respiratory arrest. The decedent's family agreed to settle this case at pre-trial mediation. Under the terms of the settlement agreement, the amount of the settlement is confidential.
Patient with spinal cord condition injured in fall
The plaintiff was hospitalized for treatment of dysphagia, an inability to swallow. This condition developed as a complication of surgery to decompress the plaintiff's cervical spinal cord. Plaintiff was at risk for falling because he had a spastic, unsteady gait related to his neurological condition; and because he had been prescribed multiple medications, including intravenous narcotics, sedatives, and analgesics. In addition, although this underweight and malnourished plaintiff was unable to swallow, hospital staff neglected to provide an alternative form of nutrition. On his sixth hospital day without nutrition, plaintiff fell while getting out of bed unassisted to go to the bathroom. As a result, he developed central cord syndrome, a severe spinal cord injury which caused permanent upper extremity weakness and loss of coordination.
The basis of the malpractice claim was the failure of the hospital's nursing staff to implement fall prevention protocols and procedures in accordance with established hospital policy.
In a related case, suit was brought against the neurosurgeon who had performed the surgery to decompress plaintiff's spinal cord. This suit alleged that the defendant negligently failed to completely decompress the spinal cord. Consequently, plaintiff was at risk for serious spinal cord injury from a minor trauma, such as a fall.
This case settled was settled during trial in the Circuit Court for Baltimore City. The amount of the settlement is confidential.
Plaintiff's verdict for delayed treatment of bowel obstruction
A Baltimore City jury awarded a 65 year old woman $2 million because her surgeon, after diagnosing a bowel obstruction, delayed urgently needed surgery for three days. As a result, the woman developed severe sepsis, which led to multiple complications, including adult respiratory distress syndrome (ARDS). Although plaintiff survived, she continues to suffer from sensory and motor neuropathies caused by prolonged confinement in the hospital's intensive care unit and dependence on a mechanical ventilator. If the surgeon had performed emergency surgery within hours after diagnosing the obstruction, as required by the standard of care, plaintiff would not have developed these life threatening complications and permanent injuries. Subsequent appeals were filed in this case.
Click here to read a newspaper account of this case.
Failure to diagnose surgical wound infection following spine surgery
Plaintiff, a 42 year old woman with "failed back syndrome", had undergone multiple lumbar spine surgeries to treat her chronic back pain. Shortly after the last of these surgeries, she developed a deep surgical wound infection. Initially, the defendant orthopedic surgeon treated the infection with oral antibiotics. However, the standard of care required him to open, explore, and debride the wound site, and to commence intravenous antibiotics, if the infection failed to resolve after 10 days of oral antibiotics. In this case, despite the presence of clear signs and symptoms of persistent infection, defendant continued to treat the infection with oral antibiotics for nearly six months. As a result, plaintiff developed chronic vertebral osteomyelitis, an incurable bone infection in the spine. This condition substantially worsened plaintiff's pain syndrome, and has impaired her ability to walk. This case settled for a high six figure amount on the fourth day of a jury trial before the Circuit Court for Baltimore City.
Watson v. UnumProvident Corporation
In this case, a federal district court judge ruled that the UnumProvident Corp., the country's largest provider of long term disability insurance, acted in an "unprincipled, if not fraudulent" manner when it terminated a Baltimore woman's long term disability benefits. The court ordered the insurer to reinstate plaintiff's benefits immediately, retroactive to the date of termination.
Plaintiff was a 56-year old woman with end stage congestive heart failure. Her treating cardiologist had repeatedly certified that she was totally disabled, even that she was at risk of sudden death on the job if she attempted to work. Prior to terminating her benefits, the insurer asked the cardiologist to send all of plaintiff's medical records for review. After legal proceedings had commenced, we discovered that her cardiologist had mistakenly sent the insurer the records of another patient. When deciding to terminate plaintiff's disability benefits, the insurer apparently failed to notice that plaintiff's file contained the wrong patient's medical records.
The court published its decision in this case, Valerie Watson v. UnumProvident Corp., 185 F. Supp.2d 579 (D. Md. 2002).
Click here to read read a report in the Wall Street Journal which cites this case as an example of UnumProvident's abusive disability insurance claims practices.
UnumProvident Corp. terminated a client's long term disability benefits, even though the client's doctors had repeatedly certified that he was totally disabled as the result of chronic pain syndrome caused by a spinal cord injury. The client's doctors further certified that his condition had steadily deteriorated since the onset of disability. UnumProvident based its decision to terminate benefits on the results of a functional capacity examination. According to the insurer, the FCE indicated that the client was capable of performing sedentary work.
After litigation commenced, it was discovered that UnumProvident had seriously misconstrued the results of the FCE. Although the client was capable of performing some sedentary work, the FCE had actually revealed that the client was capable of sustained work for no more than a couple of hours each day. When UnumProvident's erroneous interpretation of the FCE was brought to the court's attention, the insurer agreed to reinstate the client's disability benefits in full.
The family of a woman diagnosed with chronic schizophrenia filed this lawsuit after the defendant group health plan terminated the woman's inpatient hospital and medical benefits. Defendant asserted that the woman was only receiving "custodial care" at the hospital because her condition was unlikely to improve. "Custodial care" was not covered under Defendant's health plan. On behalf of the patient, we argued that her psychiatric treatment was not custodial, because she needed a trained psychiatrist to supervise and monitor her medication regime. Furthermore, the interruption of her inpatient treatment was likely to cause her mental condition to deteriorate. Ruling in plaintiff's favor, the court ordered the health plan to reinstate the patient's health care benefits for the inpatient treatment of chronic schizophrenia.
The court published its decision in this case, Robert Adelson et al v. GTE Corporation, 790 F. Supp. 1265 (D. Md. 1992)