Re: malpractice case (long)
From: ainsron@msn.com
Mon Jan 28 09:46:39 2002
If I have a patient with this history - previous surgery for tubal
adhesions, infertility, etc., I will tell them that if they become
pregnant, it is an ectopic until proven otherwise. And I tell them to
be checked early in their pregnancy, or at the first sign of symptoms -
spotting, pain. If she came into the office asymptomatic for only
pregnancy test, why is it any different than her buying an OTC pregnancy
test, or presenting to a pregnancy referral center, etc. She was given
information on the S&S of problems related to her pregnancy, had no
problems at the time (except her history), three weeks does not seem too
long to wait for an appointment for a normal pregnancy. On the other
hand, if my staff had reviewed the chart or brought it to my attention
and I recalled that I had identified her as at risk for an ectopic, I
would have tried to scan her by about six weeks.
>A 41 year old nulligravida presents to the ob/gyn office, one day late for
>her expected period for a "pregnancy test only".
>
>She is seen by the nurse - her test is positive - she is given an appointment
>for her initial ob appointment in three weeks' time. She is given a sheet
>outlining the symptoms of miscarriage and ectopic pregnancy. The patient is
>apparently overjoyed
>about her pregnancy and leaves the office. No further information is
>volunteered by the patient. The nurse places the pregnancy test record in her
>chart - but does not read her chart.
>
>The next communication with this patient is a phone call from her husband to
>the doctor on call saying that his wife has collapsed and is unresponsive. He
>is told to call 911 and to go to the nearest hospital.
>
>And now, for the rest of the story..........
>
>The paramedics apply CPR/defibrillation at the scene, she is declared brain d
>ead at the hospital. An autopsy revealshemoperitoneum with a ruptured right
>ectopic pregnancy.
>
>Examination of the patient's office chart reveals that she had used an IUD in
>the past. She presented to the office about two years prior to her demise
>complaining of infertility. Work-up revealed a right non-filling fallopian
>tube. A laparoscopy
>revealed right peritubular adhesions. These were lyzed and chromotubation
>revealed bilateral tubal spillage.
>
>But wait, the plot thickens..........
>
>In her husbands deposition, the following events come to light:
>
>She was well until 7am one the day of her demise, when he woke to find her in
>the fetal position, in pain, on the floor of their bedroom. He put her back
>on the bed, dressed and went to "work in his study". After about and hour, he
>returned to
>the bedroom to find that she was no better. Assuming that this was gas pain
>due to the Mexican food she had eaten the night before, he made a phone
>call.............
>
>To her job, to say that she was ill, and would not be in that day.........and
>went back to his work in the study - he was acomputer programmer. He was then
>disturbed about an hour and a half later by a "strange noise coming from the
>bathroom". He went in to find his wife on the toilet with her eyes rolled
>back in her head with a"gurgling noise coming from her throat", after which,
>she fell to the floor and was unresponsive. He then made a second
>call............
>
>To her primary care provider to ask for permission to take his wife to the
>emergency room. When his call was not returned, he made a call to the ob/gyn,
>who answered within minutes of getting the call ...and you know what happened
>after that!
>
>These are the relevant facts of the case.
>
>Was the case:
>1) thrown out of court?
>2) won by the plaintiff?
>3) won by the defendant?
>4) handed over to the district attorney for prosecution of the husband for
>involuntary manslaughter?
>5) settled?
>
>Comments please!
>
>Robert Modugno MD MBA FACOG
>Marietta, GA
--
Ronald E. Ainsworth, MD
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