Re: malpractice case (long)
From: ainsron@sbcglobal.net
Mon Jan 28 16:01:54 2002
I do a vaginal ultrasound on any patient who presents in the first
trimester, irregardless of history. Most come in with a positive HCG
already. I believe the limited time spent doing the sono saves a lot of
grief later - finding early twins, early blighted ovums, ectopic, etc.
>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
>
--
Ronald E. Ainsworth, MD
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