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Re: US malpractice (long)From: deborah stephens (DSTEPHENS@peacehealth.org)Mon Aug 4 05:57:04 2003
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
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