Re: malpractice case (long)
From: art fougner, md (evsono@pipeline.com)
Mon Jan 28 11:01:30 2002
why not let vaginal sonar be your pregnancy test? after the patient has
emptied her bladder, put the urine specimen to the side pending exam. if
you see a pregnancy you can assess the age and see if it matches up. if
you do not see a pregnancy, dip the urine - if negative - there you are.
if positive, then you need to draw beta's. puts you well ahead of the
game.
just my opinion - i could be wrong.
art
At Mon, 28 Jan 2002, ainsron@msn.com wrote:
>
>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
>
--
art fougner, md
ich bin ein New Yorker
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