Re: US malpractice (long)
From: art fougner, md (evsono@pipeline.com)
Tue Aug 5 07:16:44 2003
you mean cocaine was implicated?
art
At Mon, 04 Aug 2003, Gail Waldby wrote:
>
>This is remarkably similar to the famous Libby Zion case. I strongly
>suspect there were signs and symptoms of ischemic and then dead bowel long
>before the first reoperation (second operation).
>Gail Waldby, MD
>Huron Clinic SD
>
>On Mon, 4 Aug 2003 06:00:30 -0500, deborah stephens <DSTEPHENS@peacehealth.org>
> wrote:
>
>> At Wed, 4 Sep 2002, RModugno@aol.com wrote:
>>>
>>> This is from the August 2002 issue of Contemporary OB/Gyn: (Legally
>>> Speaking
>>> section)
>>>
>>> Necrotic bowel found following ovarian mass removal
>>>
>>> In 1999, a Texas woman who went to the emergency room complaining of
>>> back and
>>> abdominal pain was diagnosed with a left ovarian mass and admitted for
>>> the
>>> night. The next day she was sent home and told to come back for a
>>> "cancer
>>> workup." Two days later she returned to the emergency room with a
>>> ruptured
>>> mass. Two days after that, the woman underwent surgery, which was
>>> performed
>>> by the chief resident, with a gynecological specialist as the attending,
>>> and
>>> a general surgeon. The surgeons removed the mass and resected the
>>> omentum but
>>> did not do a frozen section because of the tumor's size and necrotic
>>> state. A
>>> pathology report returned 2 days later was negative for cancer. Over the
>>> next
>>> 8 days, the patient's nasogastric tube output increased and she
>>> experienced
>>> increasing pain and need for analgesia. Her primary physician then went
>>> on
>>> vacation and another gynecologic specialist was covering. When the
>>> original
>>> physician returned on the patient's 9th post-op day, her bowel sounds
>>> were
>>> still erratic. He ordered a gastroenterology consult, and while waiting
>>> for
>>> it, noted bowel contents leaking from the abdominal incision. Surgery
>>> was
>>> performed for what was presumed to be a fistula repair, but 80% of the
>>> woman's small bowel was found to be necrotic. After undergoing, over the
>>> next
>>> several days, four operations to remove gangrenous bowel and a
>>> hysterectomy,
>>> she was left with only 10 inches of her small bowel. The woman sued all
>>> the
>>> physicians involved with her care, contending that the covering
>>> physician did
>>> not order appropriate tests or x-rays to determine the reason her bowels
>>> were
>>> not working postoperatively. An x-ray on the fifth post-op day showed a
>>> likely ileus but could not rule out a mechanical obstruction, and she
>>> claimed
>>> that further investigation should have been done. The physicians argued
>>> that
>>> the diagnosis and surgeries were appropriate and all agreed there was an
>>> ileus. Two theories were presented as to why the bowels did not work:
>>> obstruction of the small bowel or development of a clot in the mesentery
>>> that
>>> led to infarction of the small bowel. No obstruction was found at the
>>> time of
>>> surgery and there were clots on the venous side of the mesentery. The
>>> patient
>>> promoted the theory that she had an obstruction that should have been
>>> recognized and treated sooner, and that the clots had formed after that.
>>> The
>>> physicians argued that it was an ileus with the rare complication of
>>> infarcts
>>> in the bowel. The jury awarded the patient $1 million, assigning 60%
>>> liability to the covering physician and 40% to the attending
>>> gynecologist. A
>>> high/low agreement of $750,000/$100,000 was executed, however, before
>>> closing
>>> arguments. Legal perspective A high/low agreement can be useful when an
>>> amount cannot be agreed upon by both parties to settle a malpractice
>>> case.
>>> The trial proceeds, but the parties agree in advance on a "low" amount
>>> that
>>> will be paid if the jury returns a defense verdict and a "high" amount
>>> that
>>> will be paid if the jury awards more than that amount to the plaintiff.
>>> In
>>> this case, the patient would have received $100,000 if the jury had come
>>> back
>>> with a defense verdict. Since the jury here awarded $1 million, the
>>> agreed-upon $750,000 will be paid to the patient. While this does mean
>>> the
>>> plaintiff gets something even though the jury did not necessarily think
>>> there
>>> was negligence, sometimes most of the award is used to pay expenses, and
>>> a
>>> high/low agreement can prevent the physician or his/her insurance
>>> company
>>> from paying out a ridiculously huge award.
>>> ********************************************************
>>>
>>> ********************************************************
>>> ********************************************************
>>>> From the "legal" and "financial/economic aspect" I can see the logic in
>>>> a
>>> high/low ageement. From a potential defendant's view it seems immoral
>>> and
>>> unjust. Why should the plaintiff receive one cent if the jury finds the
>>> defendant not negligent!
>>> This is but one of the reasons why we have a professional liability
>>> insurance
>>> "crisis" in the US today!
>>>
>>> Comments?
>>>
>>> Robert Modugno MD MBA FACOG
>>> Marietta, GA
>>> http://www.novaobgyn.yourmd.com
>>
>--
>Gail Waldby
>
--
art fougner, md
ich bin ein New Yorker
