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Failure to diagnose pulmonary embolism

     Five days after foot surgery, a 53-year old Frederick County man experienced shortness of breath and dizziness. He called his surgeon (a podiatrist), who suggest that he was probably just experiencing some late anesthesia side effects. The podiatrist recommended that the man  go to the emergency room or call his primary care doctor if his symptoms did not resolve within the next couple of hours. His symptoms abated until the next day, when he experienced more shortness of breath and fatigue. As instructed by the podiatrist, he called his primary care doctor, who scheduled a CT scan for the following day. The man went into respiratory arrest the following morning before the scheduled CT scan. He was rushed to the hospital by ambulance, where he coded in the ER. He died two days later as the result of a massive pulmonary embolism.

     The malpractice case was filed on behalf of the man's surviving wife, son, and daughter. The basis of the law suit was the family doctor's failure to recognize that his patient was at significant risk for developing a pulmonary embolism due to his recent surgery. The doctor should have instructed his patient to go to the ER immediately when he reported symptoms consistent with this condition. Timely evaluation and treatment most likely would have saved the man's life.

     This case settled for a confidential amount shortly prior to trial.


Small bowel perforation leads to septic shock, multiple organ failure

     Our client, a 65 year old Baltimore City man, underwent elective bowel surgery to remove a cancerous tumor. During surgery, the surgeon perforated the bowel, causing bowel contents to spill into the abdomen. Because the surgeon failed to detect and immediately repair the perforation during surgery, our client developed septic shock, multiple organ failure, and other life threatening complications. He survived his critical illness, but prolonged dependence on a mechanical ventilator while confined to the hospital's intensive care unit caused permanent lung impairment. 

     The standard of care requires a surgeon who has performed bowel surgery to meticulously inspect the portion of bowel that was operated on to detect and repair any leaks or perforations that may have occurred during surgery. A basis for this malpractice claim was the surgeon's failure to adhere to this standard.

     Additionally, Maryland law does not allow a surgeon to delegate the performance of surgery to another surgeon without the patient's informed consent. In this case, the surgeon failed to disclose that a resident in the hospital's surgical training program would perform significant parts of our client's surgery. The surgeon's failure to obtain plaintiff's informed consent was an additional basis for this lawsuit, which the parties settled for a confidential amount in mediation prior to trial.


Failure to diagnose lung cancer

     A 46 year old St. Mary's County woman was hospitalized for treatment of hyponatremia (low sodium). At the hospital, her primary care doctor ordered a chest x-ray, which revealed a small nodule on the woman's right lung. The hospital radiologist recommended that the primary care physician  obtain a follow up CT scan to evaluate the nodule. The woman never received a follow up CT scan because the primary care doctor failed to inform her about the results of the abnormal chest x-ray.

     Fourteen months later, the woman developed a severe cough and other respiratory symptoms. Her new primary care doctor immediately ordered a CT scan, which showed  a large and growing lung nodule. Further testing revealed that the woman had developed stage 4 lung cancer, which is invariably fatal. The woman died several months after receiving the terminal cancer diagnosis.

     The malpractice case was filed on behalf of the woman's surviving husband, son, and mother. The basis of the law suit was the first primary care doctor's failure to advise the woman concerning the abnormal chest x-ray and to order a prompt follow up CT scan, as recommended by the radiologist. A timely follow up most likely would have revealed that the woman had stage 1 lung cancer, which can be treated and cured in most cases. The woman's lung cancer progressed from stage 1 to stage 4 as a result of the defendant's negligent failure to follow up.

     This federal district court case was settled prior to trial in mediation before a Magistrate Judge.


Hospital fall results in femur fractures in both legs    

     Our client was a 65 year old Harford County woman who was admitted to the hospital for treatment of congestive heart failure. She was assessed to be at high risk of falling, based on her impaired mobility, lower extremity weakness, and medications. On the night before her scheduled hospital discharge, she broke both legs when she fell while attempting to walk unassisted from her bed to the bathroom.

     The basis of this hospital negligence case was the failure of the hospital nursing staff to follow established fall prevention procedures. Specifically, the nursing staff failed to answer the patient's call bell promptly; provide her with her customary assistive device, a walker; provide her with a bedside commode; utilize a bed alarm; and move her to a room close to the nurse's station where she could be monitored closely.

     This case was settled at for a confidential amount prior to trial.


Failure to diagnose necrotizing fasciitis (flesh eating bacteria)

     A 66 year old retired Baltimore City 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 in the scrotum, which had swollen to the size of a cantaloupe. The urologist, based on a cursory physical examination, attributed the swelling and pain to the man's cardiac condition. He sent the man home with instructions to rest and to call his cardiologist if his symptoms worsened. The man collapsed and died the next day. At autopsy, the cause of death was determined to be septic shock secondary to Fournier's gangrene.

    Fournier's gangrene is a form of necrotizing fasciitis (soft tissue infection) caused by microorganisms commonly known as flesh eating bacteria. Fournier's gangrene can progress rapidly in a matter of hours to life threatening sepsis. Fournier's gangrene is an absolute surgical emergency.

   The lawsuit was filed on behalf of the man's surviving adult children. The basis of the malpractice case was the urologist's failure, in light of the patient's multiple pre-existing medical conditions and serious presenting symptoms, to obtain an immediate emergency room evaluation to determine the cause of the patient's symptoms. A prompt ER evaluation would have revealed the necrotizing process. The patient most likely would have survived if the necrotizing process had been promptly diagnosed and treated.


     The parties reached a confidential settlement in this case at mediation  prior to trial.   

Podiatrist causes nerve damage to foot

     Our client was a 40 year old Prince George's County woman. She developed a painful bump on the top of her left foot after she dropped a ceramic bowl on it. Her family doctor ordered a foot x-ray, which revealed no fractures or other bone abnormalities. The family doctor diagnosed the bump to be a soft tissue cyst. He referred our client to the defendant podiatrist for further treatment.

     Even though the x-ray was normal, the podiatrist advised plaintiff that she had an exostosis, which is kind of bony growth. The podiatrist recommended immediate surgery to remove the supposed growth. During the surgical procedure, the podiatrist damaged nerves in our client's foot. As a result, she developed chronic neuritis (nerve inflammation), which eventually necessitated a another surgical procedure to sever the injured nerves. Unfortunately, severing the nerves did not alleviate our client's pain. On the contrary, she developed reflex sympathetic dystrophy (RSD) as a complication of her nerve injuries. RSD is an incurable and disabling post-traumatic pain syndrome. 

     The allegations of negligence in this case included misdiagnosis of our client's foot injury; failure to treat her condition conservatively before attempting surgery; performing unnecessary surgery; and surgical error which caused traumatic nerve injuries.

     The parties reached a confidential settlement in this case at mediation prior to trial.


Abdominal hysterectomy complications

     Our client, a 40 year old Harford County woman, developed life threatening septic shock less than 24 hours after undergoing a routine, elective hysterectomy. To determine the cause of the sepsis, the defendant gynecologist performed exploratory abdominal surgery. During the exploratory procedure, the gynecologist lacerated the patient's bladder.

     The basis of the malpractice claim was the gynecologist's negligence failure to administer prophylactic antibiotics prior to the hysterectomy. If the patient had received prophylactic antibiotics, she most likely would not have developed sepsis and other serious complications, which included disfiguring abdominal scarring, vesico-vaginal fistula (an abnormal opening of the bladder into the vagina), persistent urinary tract infections, pelvic adhesions (scarring), and post-traumatic stress disorder (PTSD).

     The parties reached a confidential settlement in this case prior to trial in the Circuit Court for Baltimore County.


Tracheostomy patient asphyxiates and dies

     A 68 year old Baltimore woman with a complicated medical history was hospitalized with breathing difficulties. Her airway had constricted as the result of a blood infection. In order to open the airway, she received a tracheostomy and breathing tube. On the day before her scheduled hospital discharge, she asphyxiated when a mucous plug obstructed her tracheostomy tube. The asphyxiation caused severe hypoxic brain damage and ultimately death.

     This hospital negligence case was filed on behalf of the woman's surviving adult children. The basis of the negligence case was the failure of a hospital nurse to adequately monitor the patient's respiratory status.  This patient required close and constant monitoring because she had, during the 24 hours prior to the asphyxiation incident, experienced multiple episodes of respiratory distress when her tracheostomy tube plugged. The nursing staff should have known that the patient was at high risk for an airway obstruction.

      The parties reached a confidential settlement in this case at mediation with a retired judge of the Maryland Court of Appeals.

Plaintiff with spinal cord condition injured in fall

     Our client was hospitalized for treatment of dysphagia, an inability to swallow. This condition developed as a complication of a recent cervical spine surgery. Our client was a fall risk because he had a spastic, unsteady gait related to a preexisting neurological condition; because his doctors had prescribed multiple narcotic, sedative, and analgesic medications; and because the hospital neglected to feed him. On his sixth day in the hospital, our client fell when he got out of bed unassisted to go to the bathroom. As a result of the fall, our client developed central cord syndrome, a severe spinal cord injury which caused permanent upper extremity weakness and loss of coordination.

     The basis of this hospital negligence claim was the failure of the nursing staff to implement fall prevention procedures in accordance with established hospital policy and nursing standards.

     In a related case, suit was brought against the neurosurgeon who had performed the recent surgery to decompress the patient's cervical spine. This suit alleged that the neurosurgeon negligently failed to decompress the spinal cord completely. Consequently, our client was at risk for the serious spinal cord injury which he sustained as the result the hospital fall.

     This case was settled during a jury trial in the Circuit Court for Baltimore City.       


$2 Million Verdict for delayed treatment of bowel obstruction

     A Baltimore City jury awarded our client, 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 our client survived, she continues to suffer from sensory and motor neuropathies caused by prolonged confinement in the hospital's intensive care unit where she was dependent on a mechanical ventilator to breathe. If the defendant surgeon had performed emergency surgery within hours after diagnosing the bowel obstruction, it is likely that our client would not have developed life threatening complications. There was an appeal in this case to the Maryland Court of Special Appeals.


Failure to diagnose post-surgical wound infection 

     Our client was a 42 year old woman with "failed back syndrome". She had undergone multiple lumbar spine surgeries to treat chronic back pain. Shortly after her last back surgery, she developed a deep surgical wound infection, which the defendant orthopedic surgeon treated with oral antibiotics. Because oral antibiotics did not clear up the infection after ten days of treatment, the standard of care required the surgeon to open, explore, and debride the surgical wound, and to administer intravenous antibiotics. Despite clear signs of persistent infection, the defendant continued to treat the infection with oral antibiotics for nearly six months. As a result, our client developed chronic vertebral osteomyelitis, an incurable bone infection which has worsened her chronic pain syndrome and impaired her ability to walk. This case settled on the fourth day of a jury trial in the Circuit Court for Baltimore City. Interestingly, post-trial interviews with the jurors revealed that the amount of the confidential settlement in this case exceeded the amount which the jurors likely would have awarded if the case had not settled.


Federal judge chastises UnumProvident Corporation, country's largest long term disability insurer

     Our client was a 56 year old Baltimore City woman with end stage congestive heart failure. Her treating cardiologist repeatedly certified that she was totally disabled, even that she was at risk for sudden death on the job if she attempted to work. Prior to terminating her disability benefits, the insurer, UnumProvident Corporation, requested all of our client's medical records from her treating cardiologist. During litigation, our review of the insurer's claims file revealed that the cardiologist had mistakenly sent another patient's records to the insurer. The insurer, however, failed to notice that our client's claims file contained the patient's medical records.

     The federal court judge ruled that because the insurer had failed to obtain and review our client's medical records, it had acted in an "unprincipled, if not fraudulent" manner when it terminated plaintiff's long term disability benefits. The judge ordered the insurer to reinstate our client's disability benefits immediately, retroactive to the date on which the insurer had terminated benefits. The federal court published its favorable decision in this important case, Valerie Watson v. UnumProvident Corp., 185 F.Supp.2d 579 (D. Md. 2002).

Another Unum case

     Unum terminated our client's long term disability benefits, even though his treating physician had repeatedly certified that he was totally disabled as the result of a spinal cord injury. The treating physician further certified that our client's medical condition had steadily deteriorated since the onset of disability. Unum based its decision to terminate our client's disability benefits on the results of a functional capacity examination. Accordingly to the insurer, the FCE demonstrated that our client was capable of full time employment at a sedentary job.

     During litigation, we discovered that Unum had seriously misconstrued the results of the FCE, which actually demonstrated that our client was capable of sustaining productive work effort for no more than a couple of hours each day. When Unum's erroneous interpretation of the FCE was brought to the court's attention, Unum agreed to reinstate our client's disability benefits.   


Insurer denies claim for accidental death benefits

     Our client was the beneficiary under an insurance policy that paid benefits if the insured, our client's spouse, died as the result of an accidental injury and no "other cause". The spouse died as the result of an intracranial hemorrhage (bleeding in the brain) caused by an accidental fall.The insurance company denied our client's accidental death claim because the insured was taking an anticoagulant medication (blood thinners) at the time of the accidental fall. The insurer asserted that blood thinners were an "other cause" of death that contributed to the size and progression of the brain hemorrhage. When applicable case law respecting the  correct way to interpret an insurance policy was brought to the insurer's attention, the insurer conceded that its interpretation of the "other cause" provision of the policy was erroneous. The insurer agreed to pay our client's accidental death claim.   


Insurer denies claim for inpatient psychiatric treatment


     The family of an adult woman diagnosed with chronic schizophrenia filed this lawsuit after the defendant group health care plan terminated the woman's benefits for inpatient psychiatric treatment. Defendant asserted that the woman's treatment was custodial because it was unlikely that her chronic psychiatric condition would ever improve. The defendant terminated the woman's inpatient psychiatric treatment benefits because custodial care was not covered under the the woman's health care plan. The court ordered the health care plan to reinstate the woman's inpatient psychiatric benefits when we pointed out that the woman needed the services of a trained physician to prescribe and monitor her medications, and that her mental condition would likely deteriorate in an outpatient setting.

     The court published its decision in this important case, Robert Adelson v. GTE Corporation, 790 F.Supp. 1265 (D. Md. 1992).