Medical Malpractice – Death after prolonged diarrhea

Case Name:    Jane Doe and Doe Children v. Roe Medical Group (Confidential)

Disposition:   $1.1 million settlement

Allegations:     Death of a 40-year-old after prolonged diarrhea

Facts: On 11/11/03, plaintiffs’ decedent, a 40-year-old husband, father of four children, and a computer technician with Etiwanda School District, presented to Roe Medical Group, complaining of diarrhea, occasionally bloody, for six days running. The physician noted that he was tachycardic and assessed him with acute gastroenteritis. She gave him Bentyl, a drug used to treat irritable bowel syndrome (IBS), advised him to increase his fluid intake, and told him to come back if necessary.

The decedent returned on 11/15 and was seen at the urgent care section of the clinic by another Roe Medical Group physician. He was still suffering from diarrhea, going on 9 days. The doctor diagnosed him with gastroenteritis, dehydration and a mild case of the flu, and started him on an IV of normal saline for dehydration. He was then sent home with a prescription for an antibiotic and instructions to stay home from work.

On 11/18, decedent’s wife called urgent care for an appointment. According to her receipts, her husband was seen at that time by a third doctor at the clinic. The clinic was unable to produce any documents pertaining to his visit other than a single “appointment history” sheet. The wife said the decedent presented in a great deal of pain, had blood in his stool and had lost his appetite. The wife recalled that he was growing steadily weaker and had more difficulty moving. The doctor did an anuscope and told the patient he had a hemorrhoid. He prescribed Kaopectate. The clinic took samples of his stool, and he was told to return in a few days if he didn’t improve.

Three days later, on 11/21, when his diarrhea was not abated and he was becoming increasingly dehydrated, the decedent returned to the clinic with a 15-day history of diarrhea. This time he was seen by a physician’s assistant, whose notes indicate that the patient had lost 17 pounds and acknowledged that he had already been seen in the urgent care for the same condition on three prior occasions. The patient’s standing pulse was 150 and sitting pulse was 136. An EKG showed him to be in sinus tachycardia. Blood was found in the rectum. The PA’s assessment was gastrointestinal bleed and anxiety. The decedent was given two liters of IV fluid and medication for his diarrhea. The PA’s notes indicate that a referral to a gastroenterologist was arranged, but nowhere in the records is there any confirmation of the referral, nor a subsequent appointment with a GI specialist. Despite the patient’s declining physical condition, the PA sent him home with a recommendation to return in three days if he didn’t feel better.

On 11/24, the decedent presented to the clinic for his fifth visit in three weeks for the same problems: severe, unremitting, occasionally bloody diarrhea. By this time he was gravely ill, and the physician in the clinic had him admitted to the hospital.

During his hospitalization over the next several days, the medical personnel performed a sigmoidoscopy, which revealed the sigmoid colon to be very inflamed, irritated and brittle, with multiple ulcerations. A laparoscopic exploration confirmed foul-smelling gas and an “inflamed” sigmoid colon along the serosa.

The sigmoid colon was not removed, but the decedent’s declining condition was documented on a daily basis. His lab results indicated that his red blood cell count, his hematocrit and his hemoglobin were steadily decreasing. On the evening of December 6th, his total hemoglobin content was very low, at 6.8, usually a sign of internal bleeding. His electrolytes were out of the normal range, and he was showing all signs of infection. He had chronic tachycardia throughout his hospital course and low blood pressure, and on that evening, despite being administered three and four liters of oxygen, his oxygenations were low. He died the following day.

Injuries/Damages: Wrongful death of a 40-year-old, gainfully employed husband and father of four children, now ages 12, 7, 4 and 18 months. The decedent’s wife was and is employed as a teacher. Plaintiffs claimed special damages in the form of past medical treatments and future lost wages of $1,154,080. They also requested general damages in the maximum amount allowed of $250,000.

Contentions: Plaintiffs claimed medical negligence and malpractice, citing the following violations of the standard of care:

  • Failure to refer the decedent to a specialist by the third visit;
  • Failure to work up and ultimately diagnose what he had, which the plaintiffs claimed was Crohn’s disease;
  • Failure to treat the decedent’s chronic tachycardia;
  • Failure to locate and repair a perforation which occurred during the sigmoidoscopy;
  • Failure to remove the sigmoid colon;
  • Failure to work up and diagnose his declining vitals;
  • Failure to identify internal bleeding;
  • Failure to transfer the decedent to the intensive care unit (ICU);
  • Failure to timely treat and repair surgical wound dehiscence and infection;
  • Failure to timely transfuse the decedent; and
  • Failure to treat his decreasing oxygenation levels.

Plaintiffs claimed that as a result of the perforation and failure to remove the infected sigmoid colon, it deteriorated and spread poisonous, purulent fluids throughout the decedent’s system. Plaintiffs noted at the time of autopsy, the entire sigmoid colon was diffusely ulcerated. Red flags of the decedent’s declining vital signs were virtually ignored by the steady stream of physicians, nurses, PA’s and other employees who saw the decedent. A medical student was the last person to administer care to the decedent, and he only administered a painkiller, with the approval of his supervising physician, despite noting an increasing pulse, low oxygen saturation levels and dramatically reduced blood pressure.

The defense took the position that the decedent suffered a “massive hematemesis” (bloody vomit) and that he aspirated and died, an unforeseeable event. The nursing aide who found the decedent testified that she found the patient with a small amount of brown fluid at the side of his mouth. She testified there was no fluid in the mouth, which is inconsistent with a massive hematemesis and aspiration.

Special Notes: After a mediation, and prior to the disclosure of medical experts, the case settled for $1.1 million, with $800,000 being allocated to the widow, and $300,000 to be placed in tax-free annuities for the four minor children, with a total guaranteed payout to them of $589,352.