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Failure to Diagnose Blood Disease Leads to Death, $1 Million Settlement | Daytona Beach Malpractice Attorney

Failure to Diagnose Blood Disease Leads to Death, $1 Million Settlement

Abnormal lab or test results are often a sign that something is not right with a patient. A doctor must use these results to determine next steps and a course of treatment.

Because that did not happen for this woman, she died just weeks after abnormal lab results. She more than likely would have survived if her condition had been correctly diagnosed earlier.

This 42-year-old female was seen by her doctor for a skin rash and signs of fatigue. Lab tests showed her blood count and platelets were normal but her blood sugar was elevated. The physician diagnosed Type II Diabetes Mellitus (DM) and prescribed an antiglycemic medication.

During the next five months, the woman was seen by the same doctor multiple times for various issues including thirst, continued fatigue, abdominal pain and rectal bleeding. An abdominal ultrasound showed slightly elevated liver enzymes and an enlarged liver consistent with fatty infiltrates. Her EKG was slightly abnormal (non-specific T wave changes), but a follow-up echocardiogram/stress test was normal.

Four months after the stress test, she saw her doctor for a sudden rash. She was given Atarax and Medrol, and returned within three weeks for lab testing. Results from the test were available within two days but her doctor did not review them until a week later. Results included decreased platelet count; continued abnormal LFTs, and an elevated HgA1C. Her doctor noted “labs awful” in her medical chart.

Four days later during an appointment, the woman said she had not been following her diet or checking her blood sugars. With ongoing skin complaints, she was diagnosed with recurrent sebaceous cysts, and given antibiotics. She was also prescribed Glucophage and encouraged to check her blood sugars and see a dietician. She was also told to stop taking aspirin and Motrin due to her decreased platelet count and to return for a follow-up in two weeks.

Two days later she developed abdominal pain again, followed by slurred speech and feelings of confusion, and was taken to the emergency room. Her lab results revealed a low hematocrit or red blood cell count (16.3), platelets of 8; with Arterial Blood Gas, Liver Function Tests, electrolytes and sugars abnormal. A head CT showed no sign of an acute bleed.

Within three hours of arrival at the ED, she suffered a grand mal seizure, which affects the entire brain, was intubated, and given two units of blood. Her temperature and heart rate were elevated, and she was transferred to a tertiary hospital. Lab work revealed increased multiple schistocytes or fragmented blood cells, suggestive of thrombotic thrombocytopenic purpura or TTP, which is a rare, life-threatening disease characterized by renal insufficiency, neurological dysfunction and a widespread aggregation of platelets throughout the body. This disease often results in blood clots in small blood vessels throughout the body and can be fatal. Less than one hour after her transfer she had a heart attack and died.

The woman’s estate sued her doctor for failure to diagnose TTP, which resulted in her death. This case was settled for more than $1 million.

Her family had a strong case based on the following factors:

The doctor did not follow symptoms to a definitive diagnosis. This diagnostic delay made the woman’s recovery less likely. This woman had many of the subtle symptoms of TTP weeks and months before her late diagnosis. TTP is a rare disease with an annual incidence in the United States estimated at 4 to 11 cases per million people. If it goes undiagnosed/untreated it has a very high mortality rate, but if caught in time, the disease responds well to plasma-exchange treatment

The doctor had too narrow of a diagnostic focus. He did not consider the seriousness of the woman’s ongoing symptoms due to her non-compliance and the belief that they were from a previously treated rash. In 54 percent of diagnosis-related malpractice cases, the provider did not order the appropriate diagnostic test or imaging — often despite an unresolved symptom or complaint.

Doctor failed to reinforce the care plan. The woman’s history of non-compliance helped mask a serious unsuspected disease. Doctors can become frustrated and less responsive to a patient’s concerns when this happens. But doctors should remind patients of the importance of following through, and documenting those discussions.

Doctor’s office did not have proper protocol for woman’s test results. The doctor did not have a good follow-up system for ensuring that tests are returned or that test results are reviewed in a timely manner. Best practices include systems that reconcile outstanding labs and referrals, to ensure that the provider is aware of the results/referral and that action is taken.

Doctor’s documentation was lacking. All documentation should support the decision-making process. Keeping records up-to-date allows providers to provide the best care for their patients and offers evidence that the care was timely and appropriate.

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