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Diagnosis Delay Results in Emergency Abdominal Surgery and Settlement | Volusia County Negligence Attorney

Diagnosis Delay Results in Emergency Abdominal Surgery and Settlement

When a patient arrives at the emergency room, it is not unreasonable to expect that an attending surgeon will examine the patient directly and also supervise the care given them by any residents.

But this patient, a 44-year-old woman complaining of severe abdominal pain, found that not to be the case.

She arrived at the emergency room with severe abdominal pain. She had undergone gastric bypass surgery two years previously. During an examination by a second-year resident, the patient described her pain as a 10, with 10 being the worst on a scale of 1-10, and pain radiating to her back.

She was not feverish and her white blood count was 8.3. Two hours later her pain was still 10/10 and she was given Morphine. A nasogastric tube was placed 30 minutes later, with no relief. A second dose of Morphine was then given to her.

Within an hour, the resident noted the woman had a firm and distended abdomen. A CT abdominal scan showed a single gallstone and was consistent for a small bowel obstruction. The resident notified the chief resident and the covering attending physician and the woman was admitted overnight for monitoring with serial abdominal exams. The attending physician was in the hospital then, but did not see the patient before leaving.

Early into the evening, the woman required two additional doses of Morphine just 20 minutes apart. The nursing notes indicate that the woman continued suffering in agony. By 11 p.m. that night, her pain was still 10/10, and she was too uncomfortable even to be interviewed by the nurse coming on duty. She was given more doses of Morphine through the evening.

The resident phoned the attending surgeon at home about midnight with concerns about the woman’s continued severe pain. The attending asked that the chief resident on-call be contacted to examine the patient and to stop the narcotics.

When the attending did not hear back from the resident, he assumed that urgent surgery was not needed.

At 1 a.m., the resident spoke by phone with the chief resident, who was not in the hospital. The chief resident did not examine the woman, attributing the woman’s pain to inflammation of the gallbladder due to the gallstone. The woman’s condition never improved through the night.

Shortly before 6 a.m., the chief resident was notified after the woman said her abdominal pain was worsening and she developed a fever of 102 degrees. The attending surgeon examined the woman for the first time at 7 a.m, nearly 17 hours after she arrived at the emergency room, and began emergency surgery at 9 a.m.. The surgeons found an intestinal volvulus or twist in the small intestine, and removed 75 centimeters of dead small intestine.

The negligent delay in diagnosing and treating this woman’s small bowel obstruction resulted in an extensive bowel infarction and a larger section being removed than would have been needed. This case was settled before trial for $1 million.

This was a successful medical malpractice lawsuit based on the following factors:

The woman was admitted to the hospital with examination by a senior physician. The need for an attending surgeon or chief resident to examine a patient will change based on the symptoms and urgency. But in complicated diagnostic situations, an attending surgeon’s knowledge, expertise and skill should be available. Timely and consistent involvement can result in earlier surgery and improved results.

The loss of bowel could have been prevented. Proper treatment for bowel obstruction should prevent the loss of bowel tissue. The doctors failed to consider the woman’s past medical history of gastric bypass surgery, which was an important omission since adhesions can form after surgery and predispose to bowel obstruction. Serial abdominal exams must be performed to see if a patient’s abdominal process is worsening, improving or staying the same.

Lack of proper protocols. The attending physician didn’t examine the woman in the proper time frame. Active involvement in the care of surgical patients by attending surgeons is vital in providing the best care and avoiding needless delays. Formal protocols for contacting the attending and recommending that he or she see the patient can help prevent complications resulting from inappropriate hesitation by the resident.

For more on patient safety, see the library of articles by Daytona Beach medical malpractice attorney.


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